How does inhalational anthrax typically present compared with cutaneous anthrax?

• A. Inhalational anthrax presents with flu-like symptoms progressing to severe respiratory involvement and mediastinal widening; cutaneous anthrax presents as a painless, necrotic eschar with surrounding edema.
• B. Inhalational presents as a local skin lesion; cutaneous presents with diffuse flu-like symptoms.
• C. Inhalational and cutaneous present identically.
• D. Inhalational causes gastrointestinal bleeding; cutaneous causes respiratory symptoms.

Answer: (A)

Inhalational (pulmonary) anthrax and cutaneous anthrax show two very different clinical patterns. The inhalational form starts with nonspecific flu-like symptoms—fever, malaise, cough—and can rapidly progress to severe respiratory distress. A key clue on imaging is mediastinal widening, caused by hemorrhagic mediastinitis from infection spreading to the mediastinal lymph nodes. This respiratory, systemic progression is what sets inhalational disease apart from the skin form.

Cutaneous anthrax, on the other hand, begins at the skin as a painless lesion that evolves into a vesicle and then a black necrotic eschar with surrounding edema. It is usually localized to the skin and does not cause the same acute, rapidly progressing respiratory failure seen with inhalational disease unless it disseminates.

So the best description contrasts a systemic, flu-like onset with rapid respiratory involvement and mediastinal widening for inhalational disease, against a localized, painless necrotic skin lesion with surrounding edema for cutaneous disease.