Case series of anthrax in IranAbstractThere are three types of anthrax and According to the evidence of several cases of gastrointestinal and meningeal anthrax in one of the villages of Iran We decided to share these rare cases and remind readers of the importance of paying attention to the history and epidemiology of anthrax.Keywords: anthrax, gastrointestinal, CNS, meningitis, Iran.1.IntroductionAnthrax is an uncommon disease. There are three defined type of anthrax: gastrointestinal, inhalation and cutaneous. The cutaneous form is the most common form, but the gastrointestinal and respiratory type has a high mortality rate (1), and If CNS involvement occurs, mortality increases. Since this disease Is not common, physiciains may not think about that and the disease may be miss diagnosed. According to the evidence of several cases of gastrointestinal and meningeal anthrax in a villages in the mountainous parts of western Iran, we decided to share these rare casesfor reminding physicians the importance of attention to epidemiology and exact history taking.Here we report foure anthrax cases all in one family living in a rural area of western Iran.2. Case PresentationCase1Case history : An 11-year-old girl was admitted to the hospital in 3 january 2023 with fever, nausea ,vomiting and decreased level of consciousness. The patient’s symptoms started 10 days ago with headache and continued with fever and nausea. The investigation started with the suspicion of meningitis or encephalitis, but the patient went into shock and was transferred to the ICU and in 4 january 2023 died.Examination : The patient’s vital signs include : temperature : 39°C , respiratory rate:30 breaths per minute, and pulse rate: 130 beats per minute and blood pressure: 90\50 mm Hg . The patient had decreased consciousness and had a stiff neck. No skin lesions were seen. Other examinations were normal.Differential diagnosis : With this history and laboratory, we thought of meningitis and encephalitis and septic shock and fungal infection and considered these as a differential diagnosis.Para clinical and laboratory findings : Laboratory studies are in table1. LP is taken, but due to the small volume of the sample received in LP, only was cultured and is not sent for analysis. The results of the patient’s blood and CSF cultures have been reported positive in less than 24 hours and the initial diagnosis was mycelium fungus, but in the re-examination, the fungal PCR is reported to be negative, and then it is announced that the bacillus is gram-positive, but its species could not be recognized. Then, the blood and csf sample was checked with BACTECT method and the diagnosis of anthrax was confirmed. [Table 1]Diagnosis: anthrax disease (gastrointestinal anthrax)Treatment: The patient died less than a few hours after admission and before diagnosis.