Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
To the Editor: Dr Borio and colleagues1 described 2 patients who died of inhalation anthrax.
Some factors in the first patient's case, however, raise concern that there
was an initial gastrointestinal anthrax infection in addition to the inhalational
illness, which became apparent later. The patient's prodrome consisted of
nausea, vomiting, and abdominal pain, diagnosed by the patient himself as
food poisoning. He did not complain of chest or respiratory symptoms on his
first visit, and the symptom constellation prompted the initial treating physician
to diagnose gastroenteritis. The postmortem examination confirmed a focal
infection of the ileum, although mesenteric nodes were apparently unaffected.
Porter RS. Evaluation of Inhalational Anthrax. JAMA. 2002;287(8):984-985. doi:10.1001/jama.287.8.983