Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
In Reply: In response to Dr Porter, the first
patient indeed had prominent gastrointestinal manifestations. In the absence
of a postmortem examination, one might have assumed that gastrointestinal
anthrax was either the primary or a concomitant mechanism of illness and cause
of death. However, postmortem examination did not reveal evidence of primary
gastrointestinal anthrax, such as mucosal ulceration of the small or large
bowel. The observed hemorrhage, necrotizing infection, and inflammation proceeded
from the serosa to the lamina propria of the submucosa, sparing the mucosa.
In addition, the mesenteric lymph nodes were unremarkable.
Borio LL. Evaluation of Inhalational Anthrax—Reply. JAMA. 2002;287(8):984-985. doi:10.1001/jama.287.8.983