Clinical presentation of cutaneous anthrax may be severe and complicated in some cases. Twenty-two cases with cutaneous anthrax were monitored between 2002 and 2008; of those two cases had toxemic shock. The lesion was localized on the anterior neck in the first case and on the right arm in the second case. In addition, both cases had an extensive edema extending from the lesion to the chest. Low systolic blood pressure (<90 mmHg), apathy and toxemic appearance, leukocytosis, hypoalbuminemia and hyponatremia were common findings in both cases. Intravenous fluid, fresh plasma replacement and penicillin G therapy were administered. One case required dopamine infusion for the restoration of shock. Crusts and other necrotic tissues on the right arm in the second case were removed surgically and were grafted. Toxemic shock is a rare complication of cutaneous anthrax and it is life threatening. Physicians working in the endemic area should be aware of this severe form.