finally to a depressed, black eschar The surrounding tissue becomes markedly edematous, but not particularly tender, distinguishing this infection from typical cellulitis This form of anthrax is quite amenable to therapy with a variety of antibiotics and, with timely institution of treatment, is rarely fatal In the 2001 outbreak, all 11 patients with cutaneous anthrax survived The one pediatric victim of the 2001 attack was a 7-month-old boy with cutaneous anthrax on his arm, presumably contracted after a brief visit to a New York City television news studio that had received contaminated mail (a similar lesion is pictured on the face of a child in Fig 132.2 ) Of note, he also developed hemolysis, thrombocytopenia, and renal insufficiency, features not usually observed in otherwise uncomplicated cases of cutaneous disease, thus raising the possibility of a particular vulnerability in infancy FIGURE 132.2 Cutaneous anthrax on the eyelids of a young child (Courtesy of Dr Larry Schwab Reprinted from Ostler HB, Maibach HI, Hoke AW, et al., eds Diseases of the Eye and Skin: A Color Atlas Philadelphia, PA: Lippincott Williams Wilkins, 2004 With permission.) The finding of gram-positive rods in skin biopsy material (in the case of cutaneous disease) or in blood smears, pleural fluid, or spinal fluid should suggest anthrax Chest radiographs demonstrating a widened mediastinum in the context of fever and constitutional signs should also lead one to consider the diagnosis