title: Subcutaneous anthrax in three intravenous drug users: a new clinical diagnosis.
abstract: Anthrax is extremely rare in the western world but is endemic to areas of south and central Asia. In early 2010 an outbreak was identified in heroin-injecting intravenous drug users in the United Kingdom and Europe. Afghanistan is currently the principal source of heroin which reaches the United Kingdom. When anthrax occurs, cutaneous disease accounts for over 95% of cases. At least 47 cases with 13 deaths have been confirmed so far. We present three cases presenting during this time with marked swelling, one resulting in compartment syndrome but all with an absence of the expected cutaneous appearances. We suggest that rather than cutaneous anthrax, these patients represent a new subcutaneous presentation of anthrax.
authors.affiliation: Department of Orthopaedics, Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom. davidknox@doctors.org.uk
authors.forename: D
authors.initials: D
authors.lastname: Knox
authors.forename: G
authors.initials: G
authors.lastname: Murray
authors.forename: M
authors.initials: M
authors.lastname: Millar
authors.forename: D
authors.initials: D
authors.lastname: Hamilton
authors.forename: M
authors.initials: M
authors.lastname: Connor
authors.forename: R D
authors.initials: RD
authors.lastname: Ferdinand
authors.forename: G A
authors.initials: GA
authors.lastname: Jones
mesh_terms: D000328:Adult; D000881:Anthrax / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D003161:Compartment Syndromes / Q000382:microbiology / Q000601:surgery; D006801:Humans; D008297:Male; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D040521:Subcutaneous Tissue / Q000382:microbiology*; D015819:Substance Abuse, Intravenous / Q000150:complications*