Gastrointestinal Anthrax with Unusual Presentation and Review of Literature

Gastrointestinal (GI) anthrax is a rare disease that occurs 2 to 5 days after the ingestion of undercooked meat contaminated with anthrax spores. The signs and symptoms of classic form include severe abdominal pain, hematemesis, melena, sudden and progressive ascites and severe diarrhea. The disease usually progresses to toxemia, shock, and eventually death in more than 50% of patients. Treatment-failure with penicillin is common. We report two cases of GI anthrax with review of literature. During 1988-1994 a total of 38 cases of human anthrax had been admitted in Sina hospital of Kermanshah (west of Iran). There were two cases of GI anthrax (5.3%) with positive culture of ascitic fluid. One of patients unexpectedly was diagnosed with vomiting and ascites and the other had only ascites. There were not any other signs and symptoms including abdominal pain or tenderness, diarrhea, hematemesis and melena. In contrast to available reports, these cases had atypical presentations. Both of them died although they had received sufficient dose of penicillin. We conclud that the GI anthrax is not as rare as reported but it may be misdiagnosed due to atypical presentation. Therefore, GI anthrax should be considered as a differential diagnosis in the case of progressive ascites and other GI presentations in endemic areas. This could help to diagnose more patients particularly in an early stage which may lead to better management of disease.