Characteristics 61-year-old woman, employed in hospital stockroom
Onset date October 25, 2001
Medical care date October 28, 2001
MMWR date 50 (43), Nov. 2, 2001
Location Manhattan, New York City
Probable source Source of exposure is unknown, although possibly she had contact with disposed September 18th letters (similar to case 19 and case 21), or with mail cross-contaminated by contact with the October 9th letters.
Disease type Inhalational anthrax
Details The patient worked in the stockroom of Manhattan Eye, Ear and Throat Hospital. She was a Vietnamese immigrant who lived alone, had no family and few friends who knew her activities. The patient became ill on October 25 with malaise and myalgias. During the next several days, she had shortness of breath, chest discomfort, and a productive cough with blood-tinged sputum. She reported no fever, chills, or night sweats. She presented to an emergency department on October 28 in respiratory distress. Her temperature was 102 F (39 C), and she was admitted to the intensive care unit and required mechanical ventilation. Initial chest radiograph revealed pulmonary venous congestion and bilateral pleural effusions; a chest computerized tomography (CT) scan revealed a widened mediastinum and bilateral pleural effusions. An echocardiogram indicated a small pericardial effusion. She was empirically treated with levofloxacin, rifampin, and clindamycin. Blood cultures grew B. anthracis less than 24 hours after admission. Her pleural effusion revealed hemorrhagic fluid and B. anthracis. The patient died on October 31.

Click for clinical details (Emerging Inf Diseases) (11-12/01)

Click for complete clinical details (JAMA) (2/20/02)

Click for additional roentgenographic details (Am J Roentgenology) (5/02)

Click for gross pathology findings (Arch Pathol Lab Med) (8/02, PDF file)

Click for news account of Kathy Nguyen (11/11/01)

Click for news account of investigation and Kathy Nguyen's funeral (11/15/01)

Click for news account of enigmatic case (11/19/01)

Click for news account of new FBI investigation team (11/28/01)

Click for news account of possible cross-contamination (12/3/01)

Click for news account of probable cross-contamination with Leahy letter (12/4/01)

Click for news account of negative tests near her home (12/5/01)

Click for news account of treatment (2/20/02)

Click for CDC summary of possible exposure analysis (4/2/02)

Click for cross-contamination theory of 10-100 spores (5/14/02)

Click for follow-up of Nguyen's deathnearly seven years later (8/07/08)

Death date October 31, 2001