Abstract: A 58-year-old male patient presented with a 10-day history of purplish-red plaques and ulcers on the right forearm and a 2-day history of fever, with a history of exposure to sick sheep. No typical pathological features were observed on histological examination. The nucleic acid test for Bacillus anthracis was negative, and bacterial culture of the lesion secretion yielded positive for Staphylococcus epidermidis. The patient was initially diagnosed with sheep pox and treated with intravenous meropenem combined with linezolid, which achieved a certain therapeutic effect. However, considering that the patient had a high fever of 39.6℃ and the skin lesions were highly suspicious for anthrax, ulcer tissue specimens were collected for metagenomic next-generation sequencing of microbial DNA (mNGS-DNA). The sequencing result was positive for Bacillus anthracis. The anti-infective regimen was adjusted to penicillin combined with linezolid for continuous treatment for 2 days. Subsequently, the local swelling gradually subsided, the blisters on the skin lesions dried up, and the black eschar gradually fell off. The patient was then transferred to a specialized infectious disease hospital for further isolated treatment.

Key words: cutaneous anthrax, orf, metagenomic next-generation sequencing (mNGS)