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Case Reports in Medicine
Volume 2015, Article ID 325093, 5 pages
http://dx.doi.org/10.1155/2015/325093
Case Report

First Autochthonous Coinfected Anthrax in an Immunocompetent Patient

1Referral Laboratory, Mazandaran University of Medical Sciences, Sari, Iran
2Invasive Fungi Research Center and Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
3Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
4Department of Medical Mycology and Parasitology, Kurdistan University of Medical Sciences, Sanandaj, Iran
5Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
6Antimicrobial Resistance Research Center, Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran
7Mazandaran University of Medical Sciences, Sari, Iran
8CBS-KNAW Fungal Biodiversity Centre, Utrecht, Netherlands
9Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
10Pharmaceutical Sciences Research Center and Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran

Received 13 April 2015; Accepted 13 July 2015

Academic Editor: Jeffrey M. Weinberg

Copyright © 2015 Parvaneh Afshar et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cutaneous anthrax has a mortality rate of 20% if no antibacterial treatment is applied. The clinical manifestations of cutaneous anthrax are obviously striking, but coinfection may produce atypical lesions and mask the clinical manifestations and proper laboratory diagnosis. Anthrax is known to be more common in the Middle East and Iran is one of the countries in which the zoonotic form of anthrax may still be encountered. We report a case of a 19-years-old male who used to apply Venetian ceruse on his skin. Venetian ceruse (also known as Spirits of Saturn) is an old cosmetic product used for skin whitening traditionally made from sheep’s spinal cord. The patient referred to the Referral Laboratory, Mazandaran University of Medical Sciences, Sari, Iran, with atypical dermatosis, pronounced pain, and oedema of the affected tissue. It was confirmed by both conventional and molecular analysis that culture was a mixture of Bacillus anthracis and Trichophyton interdigitale. The patient was initially treated with ceftriaxone (1000 mg/day for two weeks), gentamicin (1.5–2 mg/kg/day), terbinafine (200 mg/week for one month), and 1% clotrimazole cream (5 weeks) two times per day which resulted in gradual improvement. No relapse could be detected after one-year follow-up. Anthrax infection might present a broader spectrum of symptoms than expected by clinicians. These unfamiliar characteristics may lead to delayed diagnosis, inadequate treatment, and higher mortality rate. Clinicians need to be aware of this issue in order to have successful management over this infection.