Fatal inhalational anthrax with unknown source of exposure in a 61-year-old woman in New York City.
A 61-year-old woman who was a New York City hospital employee developed fatal inhalational anthrax, but with an unknown source of anthrax exposure. The patient presented with shortness of breath, malaise, and cough that had developed 3 days prior to admission. Within hours of presentation, she developed respiratory failure and septic shock and required mechanical ventilation and vasopressor therapy. Spiral contrast-enhanced computed tomography of the chest demonstrated large bilateral pleural effusions and hemorrhagic mediastinitis. Blood cultures, as well as DNA amplification by polymerase chain reaction of the blood, bronchial washings, and pleural fluid specimens, were positive for Bacillus anthracis. The clinical course was complicated by liver failure, renal failure, severe metabolic acidosis, disseminated intravascular coagulopathy, and cardiac tamponade, and the patient died on the fourth hospital day. The cause of death was inhalational anthrax. Despite epidemiologic investigation, including environmental samples from the patient's residence and workplace, no mechanism for anthrax exposure has been identified.
Mina
Bushra
B
Section of Critical Care Medicine, Department of Medicine, Lenox Hill Hospital, 100 E 77th St, New York, NY 10021, USA. bmina@lenoxhill.net
Dym
J P
JP
Kuepper
Frank
F
Tso
Raymond
R
Arrastia
Carmina
C
Kaplounova
Irina
I
Faraj
Hasan
H
Kwapniewski
Agnieszka
A
Krol
Christopher M
CM
Grosser
Mayer
M
Glick
Jeffrey
J
Fochios
Steven
S
Remolina
Athena
A
Vasovic
Ljiljana
L
Moses
Jeffrey
J
Robin
Thomas
T
DeVita
Maria
M
Tapper
Michael L
ML
D000784:Aortic Dissection / Q000175:diagnosis / Q000209:etiology; D000881:Anthrax / Q000175:diagnosis*; D001014:Aortic Aneurysm / Q000175:diagnosis; D001408:Bacillus anthracis / Q000235:genetics / Q000302:isolation & purification*; D023482:Bioterrorism; D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D004781:Environmental Exposure; D017809:Fatal Outcome; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis; D006333:Heart Failure / Q000175:diagnosis; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000209:etiology*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D009519:New York City; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology*; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology*; D011014:Pneumonia / Q000175:diagnosis; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012141:Respiratory Tract Infections / Q000175:diagnosis*; D013171:Spores, Bacterial
D004269:DNA, Bacterial