Rationale: Anthrax is a zoonotic disease caused by spores of Gram-positive Bacillus anthracis, commonly affects mammals and in rare cases birds. Human infection occurs accidentally through direct or indirect exposure to animal or their products. Patient concerns: A 63-year-old man was referred to our hospital with flu-like symptoms and severe swelling and redness on the face, the roof of the mouth, and nostrils. He had a history of direct contact with a slaughtered mutton two days ago. He declared controlled diabetes, hypertension, hypertriglyceridemia, and heart failure. Lungs were normal in lung high resolution CT, but multiple lymphadenopathies were seen in the mediastinum. Bilateral axillary lymphadenopathy with a maximum sad of 23 mm and pleural effusion on the right side was observed. CT scan of the nose and sinuses showed an increased density of polyps in the left maxillary sinus. Slides were prepared from the patient's lesions and examined under a light microscope. Bacillus shape with Streptococcus bacteria was seen. Diagnosis: Anthrax co-infection with herpes systemic virus andStreptococcus pyogenes. Interventions: Multidrug therapy started with appropriate antibiotics. Outcomes: The symptoms of the patient gradually disappeared. The patient was discharged without any complications. Lessons: Cutaneous anthrax in endemic areas in patients with skin presentations and a history of contact with infected animals or products should be considered a differential diagnosis. This is more important in mixed infections where the main cause of the problem may be hidden.
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