What are the hallmark early clinical features of inhalational anthrax?

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Inhalational anthrax classically starts with a nonspecific prodrome: fever and malaise with fatigue, often accompanied by a dry cough and chest symptoms. This then progresses rapidly to dyspnea and signs of respiratory distress. A key clue is the imaging finding of mediastinal widening, reflecting hemorrhagic mediastinitis from infection of the mediastinal lymphatics. This combination of an initial flu-like illness with chest symptoms followed by dyspnea and mediastinal widening on imaging is what makes the early features distinctive. The other options don’t fit this pattern: a vesicular rash suggests other viral or dermatologic conditions, while severe diarrhea or jaundice are not typical early manifestations of inhalational anthrax.