Two cases of gastrointestinal anthrax with an unusual presentation from Kermanshah (western Iran).

During 1988-1994 a total of 38 cases of human anthrax were admitted to Sina Hospital in Kermanshah (western Iran). There were two cases of gastrointestinal anthrax (5.3%) with culture positive ascitic fluid. Among the many reported gastrointestinal signs and symptoms, unexpectedly one of our patients had only vomiting and ascites whereas the other case had only ascites. Neither had abdominal pain, tenderness, diarrhea, hematemesis, melena, or other expected signs and symptoms of anthrax. Therefore, in contrast to the available reports, these cases presented atypically and despite receiving a sufficient dose of penicillin, the drug of choice at that time, both patients died. Gastrointestinal anthrax is not as rare as reported but due to an unusual presentation it may be misdiagnosed. Paying attention to gastrointestinal anthrax in the differential diagnosis of ascites with unknown origin and other gastrointestinal presentations in endemic areas may help to diagnose more cases of anthrax. Timely appropriate management in an early stage of the disease, may increase their chances of survival.