The second cutaneous anthrax infection diagnosed by metagenomic next-generation sequencing: A case report

Rationale: Anthrax is a severe zoonotic infectious disease caused by Bacillus anthracis. Most reported cases were traditionally diagnosed through culture and microscopy. We reported here the second case of cutaneous anthrax diagnosed by metagenomic next-generation sequencing (mNGS). Patient concerns: A 63-year-old man had a history of contact with an unwell sheep, developing local redness and swelling on wrist. The dorsal side of the left hand and forearm, with tension blisters on the back of the left. Diagnosis: B anthracis was detected from culturing and mNGS of tension blisters. Interventions: On the second day of admission, the patient was administered 3.2 million units of penicillin every 6 hours, and isolated and closely observed. Outcomes: The patient improves and is discharged. Lessons: Traditional bacterial cultures are time-consuming, while mNGS offers the advantage of accurate, quick, high-throughput, unbiased sequencing of all genetic material in a sample, which is a good technical tool for assisting in the diagnosis of rare pathogen infections.