Age: 29.0
Sex: M
Vaccine: ANTH
Symptoms: Erythema, Fungal infection, Pruritus, Rash
Clinical narrative: 10/21/02 Received my first Anthrax shot. No noticeable effects within the first couple of days except for the typical soreness and slight uncomfortable bump on the arm. 10/25/02 Within a week of taking the shot, I suddenly had a case of what looked like athlete's foot take hold and spread through my toes. I immediately began treating it with both Micatin spray and Gold Bond foot powder to dry out my feet. I continued to change socks twice a day while at work also. It seemed to slow the spread for a while. 10/28/02 One day I woke up and the rash had spread over the tops of both my feet and all the way up to the ankles of both feet. It itched severely and the Micatin and foot power didn't help anymore. 11/2/02 With the rash still covering my feet, I attended squadron officer school for the next 6 weeks. 11/4 - 11/20/02 During this time the rash went in varying phases. It would get worse and then better. I was still using foot powder and Micatin with little to no results. About a week before Thanksgiving I noticed this rash had spread to my inner thighs and arms. It was especially bad around the elbows and upper arms. I saw a physician's assistant at the clinic and she prescribed an oral antifungal Ketacozonal and a topical antifungal cream Nizoral. After a week of use the symptoms were better and the red rash like areas went down some but did not disappear. 11/27 - 12/01/02 I flew home for the Thanksgiving and had just finished up the supply of Ketacozonal. During the plane flight home, I was unable to change socks and apply cream to the affected areas. When I got off the plane and was picked up both my feet and the affected areas on my arms were itching so bad that I decided to visit the emergency room. When I arrived they had 4 different doctors look at my symptoms and try to diagnose what I had-whether it was fungal or my immune system responding to something. They finally decided to try an Oral Steroid and topical steroid cream. For the next four days I took the medicine prescribed and I also soaked my feet and arms in baking soda and water three times per day. My rash receded and looked better than it had for the past month. However, it did not entirely go away. 12/2/02 - 12/18/02 I returned to squadron officer school and completed the course. About a week after things had really started to clear up the rash resurfaced and reached the same spread intensity of it's worse previous level. I scheduled an appointment with the PA again. I told her of my visit and how they had prescribed steroids and thought maybe it was an immune system response or Psoriasis instead of fungal. She gave me some more steroids and helped me set up an appointment with the dermatologist. I had to cancel the appointment with the dermatologist due to the ensuing typhoon on Guam and the fact that I had to return to help with recovery efforts at my  duty station. 12/20/02 Upon arriving in Guam I scheduled an appointment with my healthcare provider. He examined my feet, took digital pictures, and sent these pictures to the dermatologist at the hospital. The doctor examined me about a week later and after take a sample of my skin and looking at the microscope he couldn't tell if it was fungal or not. 1/15/03 To date the rash has receded until its just a slightly discolored red spot on top of my feet. It still itches, however and hasn't completely disappeared while I've been taking Lamasil and putting ointment on it for the past 3 weeks. Since the start, I've had the rash for almost three months now. I've tried both antifungals and steroids and both seem to work somewhat. During this entire 3 month period I've never changed the soap I shower with, the shampoo, or the laundry detergent I use. These possible causes were suggested to me by all the doctors. The only thing that stands out as different is the fact that I received my first Anthrax shot just as this all started. The rash when it was fully developed consisted of red, itchy area with small bumps filled with a clearish/yellowish fluid. These bumps were very easily ruptured. Once the skin would dry out, it would crack and the clear fluid would leak up through the cracks in my skin.