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Yushan Liu,1,2 Gezhi Zheng,1,3 Jing Li,1,3 Nan Yang,1– 4 Juan Li,1,2 Zhengwen Liu,1– 4 Qunying Han,1– 4 Yingren Zhao,1– 4 Fenjing Du,1,3 Yingli He,1,* Taotao Yan1,* 1Department of Infectious Diseases, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China; 2Institution of Hepatology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China; 3Clinical Research Center for Infectious Diseases, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China; 4Shaanxi Clinical Research Center for Infectious Diseases, Xi’an, Shaanxi, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yingli He; Taotao Yan, Department of Infectious Diseases, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 Yanta Road(w), Xi’an, Shaanxi, People’s Republic of China, Tel +86 189-9123-2863 ; +86 186-9148-5175, Email heyingli2000@xjtu.edu.cn; yantaotao_sweet@163.comAbstract: Anthrax is caused by Bacillus anthracis. Humans are mainly infected through contact with the fur and meat of livestock. The cutaneous form is the most common form. The skin lesions of typical cutaneous anthrax are characterized by shallow ulcers with black crusts, surrounded by small blisters and nonpitting edema of nearby tissues. Metagenomic next-generation sequencing (mNGS) is a new pathogenic detection method which is rapid and unbiased. We reported the first case of cutaneous anthrax diagnosed by mNGS. Ultimately, the man received prompt antibiotic therapy and had a good prognosis. In conclusion, mNGS is proved to be a good method for etiological diagnosis, especially for rare infectious diseases.Keywords: cutaneous anthrax, metagenomic next-generation sequencing, mNGS, case report, etiology diagnosis

Additional file 1: Appendix S1. Search strategy.

Additional file 2: Appendix S2. Grading systems used in the appraised CPGs.