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Correspondence
Injection anthrax causing compartment syndrome and necrotising fasciitis
  1. Benjamin J Parcell1,
  2. Andrew D Wilmshurst2,
  3. Anthony J France3,
  4. Luisa Motta4,
  5. Tim Brooks5,
  6. William J Olver1
  1. 1Department of Medical Microbiology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
  2. 2Department of Plastic Surgery, Ninewells Hospital and Medical School, Dundee, Scotland, UK
  3. 3Infection Unit, Ninewells Hospital and Medical School, Dundee, Scotland, UK
  4. 4Department of Pathology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
  5. 5Health Protection Agency Centre for Emergency Preparedness and Response, Novel and Dangerous Pathogens, Porton Down, Salisbury, UK
  1. Correspondence to Dr Benjamin J Parcell, Medical Microbiology, Ninewells Hospital and Medical School, Dundee, Tayside DD1 9SY, Scotland, UK; b.parcell{at}nhs.net

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A 28-year-old woman was diagnosed with injection anthrax infection causing compartment syndrome and necrotising fasciitis of her arm. She was treated successfully with intravenous benzylpenicillin, clindamycin, ciprofloxacin and metronidazole. While in hospital she underwent two fasciotomies and six debridements of necrotic tissue over a 3-week period. Subsequent skin grafting was successful.

Case report

A 28-year-old female intravenous drug user presented with a 2-day history of increasing pain and swelling in her right arm, extending to her right shoulder. She had last injected heroin into her right antecubital fossa 5 days previously.

On admission she was feverish at 38°C and tachycardic. There was massive swelling of the arm, extending from her fingers to her shoulder, but no overt erythema. Initial laboratory findings revealed total white cell count of 15.5×109/l, with neutrophilia and C-reactive protein of 38. She was diagnosed with compartment syndrome and was taken to theatre the same day for multicompartment fasciotomy. On inspection, all tissue looked viable and no abscesses were identified. Swabs taken at surgery did not yield any growth on culture.

At this stage, this was considered to be a possible case of anthrax as the patient was an intravenous …

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