A 45 year old veterinary surgeon presented with a black eschar on the left hand. There was extensive swelling around the ulcer but it was not painful. There were few vesicular lesions surrounding the ulcer. He presented a history of injury to the hand while handling animals. What would be the presumptive diagnosis on the basis of history and culture smear of fluid from the vesicles?

**Core Concept**
The case presented suggests a zoonotic infection, which is a disease or infection that can be transmitted from animals to humans. The patient's history of handling animals and the presentation of a black eschar with vesicular lesions are key indicators of such an infection.

**Why the Correct Answer is Right**
The presence of a black eschar and vesicular lesions is characteristic of cutaneous anthrax. Cutaneous anthrax occurs when the spores of *Bacillus anthracis* enter the body through a cut or scratch in the skin, often as a result of handling infected animals or their products. The spores germinate, and the bacteria multiply, causing the characteristic black eschar and vesicular lesions. The lack of pain around the ulcer is also consistent with cutaneous anthrax.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it suggests a diagnosis of rat bite fever, which is caused by *Streptobacillus moniliformis* or *Spirillum minus*. While rat bite fever can present with skin lesions, it is typically associated with a painful bite wound and a history of rat exposure.

**Option B:** This option is incorrect because it suggests a diagnosis of leprosy, which is caused by *Mycobacterium leprae*. Leprosy typically presents with skin lesions and nerve involvement, but it does not typically cause a black eschar or vesicular lesions.

**Option C:** This option is incorrect because it suggests a diagnosis of ecthyma gangrenosum, which is a skin manifestation of *Pseudomonas aeruginosa* sepsis. Ecthyma gangrenosum typically presents with painful skin lesions and is not associated with a history of handling animals.

**Option D:** This option is incorrect because it suggests a diagnosis of necrotizing fasciitis, which is a severe skin and soft tissue infection caused by *Streptococcus pyogenes* or *Staphylococcus aureus*. Necrotizing fasciitis typically presents with severe pain and systemic symptoms, and is not associated with a black eschar or vesicular lesions.

**Clinical Pearl / High-Yield Fact**
When encountering a patient with a black eschar and vesicular lesions, especially in the context of animal exposure, cutaneous anthrax should be a top consideration. Remember the classic presentation of cutaneous anthrax: a black eschar with vesicular lesions, lack of pain, and a history of animal exposure.

**Correct Answer:** B. Cutaneous anthrax.

✓ Correct Answer: C. Cutaneous anthrax