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A 17-year-old girl presented to the emergency department with a black necrotic lesion on her left cheek and periorbital edema. She had been well until 15 days before presentation, when she noticed a small, painless, pruritic papule on her face that quickly enlarged and developed a central vesicle. The vesicle burst, leaving a painless necrotic ulcer with a black, depressed eschar. Extensive edema of the eyelids developed and progressed over a period of 7 days. At presentation, she was afebrile, and there was no lymphadenopathy. A diagnosis of cutaneous anthrax was made and confirmed by Gram's staining of the ulcer, which revealed gram-positive spore-forming bacilli consistent with Bacillus anthracis. The patient was from a northern Iranian village where exposure to contaminated soil and livestock products is common; no bioterrorism was suspected. Intravenous penicillin G (at a dose of 6 million units given every 6 hours for 10 days) was administered. On follow-up, the patient was well, and the eschar was healed, with very little skin atrophy.
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