Abstract
Introduction: Anthrax remains endemic to some parts of southern India including Pondicherry. Among various forms of the infection, gastrointestinal anthrax appears to be the least common. Cases of inhalational anthrax causing sepsis and disseminated intravascular coagulation have been reported in the literature. Case presentation: We report the first case, to the best of our knowledge, of gastrointestinal anthrax with sepsis and disseminated intravascular coagulation from India. The patient ate raw meat under the influence of alcohol, following which he developed fever and gastrointestinal bleeding. Later, he presented with ascites, intracerebral haemorrhage, haematuria and a deranged coagulation profile. Culture of his blood yielded Bacillus anthracis. He succumbed to the infection after 18 h of admission in the intensive care unit. The case was reported to the public health authorities for the necessary follow‐up and preventive measures. Conclusion: Gastrointestinal anthrax can have various non‐specific clinical manifestations, making diagnosis difficult. Meticulous history taking, a high index of suspicion and prompt institution of antibiotics with or without surgical intervention is likely to improve outcomes.
Highlights
Anthrax remains endemic to some parts of southern India including Pondicherry
Inhalational anthrax is a serious form with high mortality, reported increasingly in the recent past as a consequence of bioterrorism in the USA (Borio et al, 2001)
Several cases of cutaneous anthrax leading to meningoencephalitis with 100 % mortality have been reported from Pondicherry (Kumar et al, 2000a, b; Narayan et al, 2009)
Summary
Anthrax is a potentially fatal zoonotic disease found in both humans and animals. It is caused by Bacillus anthracis, a Gram-positive, non-motile, spore-forming, rod-like, aerobic bacterium. Humans can acquire infection either by handling the infected animal or its products such as hide or by consumption of undercooked meat It can present in different forms – cutaneous, inhalational and gastrointestinal. A 50-year-old gentleman, a farmer by occupation with a long history of alcohol excess, presented to the emergency department with complaints of fever and malaena for 1 week. He had one episode of tonic clonic seizure on the day of admission. A provisional diagnosis of sepsis with DIC and decompensated chronic liver disease with hepatic encephalopathy was made He was treated with transfusions of platelet concentrates and fresh frozen plasma, and intravenous ceftriaxone, metronidazole and oral rifaximin, pending blood and urine culture reports.
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