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July 3, 2002

Diagnosis and Treatment of Cutaneous Anthrax

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(1):43-44. doi:10.1001/jama.288.1.42

To the Editor: Dr Freedman and colleagues1 report the occurrence of microangiopathic hemolytic anemia in a case of cutaneous anthrax. This represents the second recent anthrax case with this finding.2 Pathological reports of inhalational anthrax cases from the Sverdlovsk epidemic3 suggest that vasculitis is the cause of the microangiopathic hemolytic anemia observed in some cases of anthrax. Although pathological findings of disseminated intravascular coagulation were not reported to be present in the Sverdlovsk cases, laboratory findings compatible with the diagnosis occurred in some patients. The vasculitis, as well as endothelial damage, were believed to be responsible for the extensive hemorrhage that is a prominent feature in disseminated anthrax infections. Thus, both microangiopathic hemolytic anemia and hemorrhage may be consequences of vasculitis.

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