Presumed cutaneous ocular anthrax with signs of orbital cellulitis

ABSTRACT

We saw eight patients, four male and four female, ranging from 10- to 40-year in age, who had unilateral redness, itching, and marked swelling of the eyelids and periorbital area. The edema also extended to the entire face, the opposite eye, the forehead, and the postauricular region. All patients had severe constitutional symptoms and intense headache. The inflammation extended posteriorly into the orbit, with restriction of globe motility to a varying degree in all patients and signs of optic disc involvement in some of them, mimicking a cavernous sinus thrombosis. These patients recovered only when heavy doses of intravenous penicillin [2.4 million units daily in continuous drip], alongwith oral ibuprofen 400 mg t.i.d., were added to their management. The swelling gradually subsided over a period of several days with formation of a black eschar on the involved area of the affected eyelid. Weeks later, the eschar fell off, leaving behind a badly scarred eyelid with severe ectropion which needed extensive plastic repair. Although cultures in our laboratory did not confirm it, we strongly suspect these to be the cases of cutaneous anthrax of the eyelid. Further study is in progress to learn the source of Bacillus anthracis in the area to which these patients belong