Anthrax: A Rare Cause of Periorbital Cellulitis and Cicatricial Ectropion

Among the three forms of anthrax in human (cutaneous, inhalational, and gastrointestinal), cutaneous anthrax is the most common form with prevalence of 95%. The cutaneous anthrax is a rare cause of periorbital (preseptal) cellulitis that may remained without correct diagnosis and appropriate treatment. This may result in severe local complications such as blindness and airway obstruction or dissemination of the disease like as bacteremia and meningitis. We report a child with periorbital anthrax to present the clinical manifestation and progression of the disease and remind physicians the interesting contagious cause of periorbital cellulitis. Case report: A 2.5-year-old boy from a rural area of Guilan province in Iran was seen to have a small erythematous papule in his right lower eyelid 5 days prior to admission. Then, the lesion progressed to a necrotic ulcer with a black central scar and severe surrounding edema and erythema. Severe swelling of the eyelids and edema all over the face occurred as well. Fever was absent. The child had repetitious contacts with domestic herbivores. The CT scan of the orbit and paranasal sinuses showed soft tissue swelling only. Gram-positive rods were seen in the smear of exudate taken from cutaneous lesion but culture result showed negative. Treatment with intravenous ciprofloxacin, penicillin, and clindamycin resulted in clinical improvement but due to cicatricial ectropion formation, oculoplastic intervention was considered to be done. Physicians must consider a cutaneous lesion to be anthrax if any of the following exists: a history of contact with domestic herbivores and animals, similar lesions in the family members, cutaneous necrotic ulcer with the characteristic black scar and peripheral edema, and observing gram-positive rods in scraped material taken from beneath the scar edge or exudate of cutaneous lesions. Although anthrax of the eyelids is not common, it must be included in the differential diagnosis of periorbital cellulitis.