A 17‐Year‐Old Girl with a Black Eschar

A 17-year-old girl developed a cutaneous macular lesion in the area of the right sternoclavicular joint. In the 3-week period after initial symptoms were noted, the lesion passed through papular, vesicular, and pustular stages before forming a hard black eschar (diameter, 2 cm) with erythema and edema, as well as regional lymphangitis (figure 1). In the early stage of the disease, the patient experienced malaise and had subfebrile temperatures. After treatment with several different antibiotic regimens (clindamycin-clarithromycin, then fucidine-imipenem-ciprofloxacin), the patient was admitted to our hospital with suspected cutaneous anthrax. In contrast with the painful lymphangitis, the eschar was painless, and it was adherent to the underlying tissues (figure 2). The patient was in good clinical condition and did not show any systemic symptoms. Her C-reactive protein level (5.6 mg/L) and leukocyte count (8200 cells/µL) were normal. Blood culture results remained negative. The patient lived on a cattle farm, and her household included 3 domestic cats. She denied any recent animal, tick, or mosquito bites. None of the animals on the farm were known to be ill. Two weeks before the onset of symptoms, the patient had purchased a neck scarf in an ethnic specialty shop.