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February 27, 2002

Evaluation of Inhalational Anthrax—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(8):984-985. doi:10.1001/jama.287.8.983

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.