This paper illustrates a case of acute confusional state in patient with anthrax sepsis who has been previously diagnosed as being suspect to delirium tremens and phlegmona antebrachii lateris dextri by the emergency physician, then referred to the Intensive Care Unit of the Department of Psychiatry Tuzla in June 2002. Upon the admission, due to unclear clinical picture and a lack of heteroanmnestic data the patient was subject to an extended diagnostic procedure, and diagnosed with an acute confusional state in anthrax sepsis referred to the Department for Infectious Diseases for further treatment. In introduction that consists of usual history information, the authors give a brief description of acute confusional state in anthrax sepsis and their own experience in diagnostic evaluation and treatment of this complex clinical syndrome. Diagnostic criteria used are DSM-IV and I WATCH DEATH mnemonic.