Inhalational anthrax follows the deposition of sporebearing particles into alveolar spaces. From there, they are transported to the mediastinal lymph nodes. Subsequent germination within the lymph nodes leads to a massive release of bacteria and toxins into the bloodstream. The incubation period is usually less than 1 week, but it can be as much as 6 weeks. Initial symptoms of the clinically and fairly consistent 2-stage disease are nonspecific, with fever, chills, myalgia, cough, and sore throat [26] . Substernal chest pain, dyspnea, abdominal pain, nausea, and vomiting are common. With disease progression for 2 to 3 days, severe pneumonitis develops, and abruptly, sepsis, hypoxemia, cyanosis, and shock follow. Prominent shortness of breath reflects thoracic lymphadenitis and mediastinitis rather than bronchopneumonia. However, inhalation anthrax can sometimes present without the usual symptoms of chest pain and shortness of breath [27] .