Medical experts are calling out a rotten batch of news articles that wrongly claimed spoiled leftover Chinese food caused a teen to develop a life-threatening infection within hours, which led to the amputation of both his legs below the knees and parts of all 10 of his fingers.

In reality, the 19-year-old male suffered a rare and extremely severe complication from a blood infection with a bacterium that causes meningococcal disease. The bacterium—known as Neisseria meningitidis—is not foodborne, and its incubation period is longer than just a few hours.

N. meningitidis harmlessly colonize the noses and throats of about 10 percent of people. It spreads through very close contact and directly swapping saliva, such as through coughing, kissing, and living in close quarters, like dormitories. Given the risk in group settings, many colleges and universities require students to get meningococcal vaccines before attending. Still, there has never been a documented case of N. meningitidis spreading via food.

But you might not have gotten that idea from the numerous news articles which spread the alarming suggestion that the forgotten takeout lurking in the back of our refrigerators could kill you in a matter of hours if you dared take a bite. The fallacious warning was likely amplified by YouTuber Bernard Hsu, known as Chubbyemu, who posted a lengthy dramatization of the case that has been viewed 1.5 million times. “I don’t intend to scare anyone about food or leftovers,” he said at the beginning, before calling the case a “freak accident.”

The real accident came from misreading a case record of the man’s condition, which was published more than a year ago in The New England Journal of Medicine. NEJM regularly features articles in a series titled “Case Records of the Massachusetts General Hospital.” The records present unusual or puzzling medical cases in an explanatory way for educational purposes. The articles always lay out how a particular case was handled, starting with how a patient first presented to doctors and what medical history they provided, then going through the tests, steps, and decisions the attending doctors took. The articles end with the doctors’ final diagnosis, treatment, and the patient’s outcome.

Red herring

In the March 2021 case record, a 19-year-old male was admitted to a pediatric intensive care unit because of shock, multiple organ failure, and a rash. The outset of the article described doctors doing their normal run-through of the teen’s medical history, noting incidentally that he had reported eating “rice, chicken, and lo mein leftovers from a restaurant meal” about 20 hours before landing in intensive care. He reported nausea, vomiting, and abdominal pain after the meal, which could have been linked to the leftovers. But those symptoms were followed up by chills, generalized weakness, progressively worsening diffuse muscle pain, chest pain, shortness of breath, headache, neck stiffness, and blurry vision. The medical history also noted that a friend of the patient had also eaten the maligned leftovers and vomited shortly afterward but then felt fine.

The article went on to note other bits of the teen’s history, such as that he smoked two packs of cigarettes a week, smoked marijuana daily, used a cough-suppressant and antihistamine recreationally, and had intermittent ear infections as a child. He lived in northern New England, but in the days preceding his illness, he had been staying with a friend and visited the beach and a music venue.

The article never mentioned the leftovers again—because the food wasn’t linked to his illness. The lo mein was simply a red herring that the doctors dismissed, according to the article’s editor and director of the clinical microbiology laboratory at Massachusetts General Hospital, Eric Rosenberg.

In an interview with the Boston Globe, Dr. Rosenberg expressed his surprise and disappointment that news stories had linked the teen’s case to leftover food.

“It was completely irrelevant to this patient’s presentation,” Rosenberg said, adding that the doctors on the case never thought that spoiled food caused the illness. “It was horrifying that this is how medical disinformation can be so easily disseminated… There were more media outlets than I can count who picked up on this and were reporting on it.”

Baloney

Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center and medical director of the National Foundation for Infectious Diseases, echoed his sentiment to the Globe. “There’s absolutely no history in the medical literature of this kind of bacteria being transmitted by food,” he said. “It’s baloney.”

In a debunking article by Everyday Health, UNC infectious disease expert Joseph Duncan also noted that there has never been a documented case of foodborne N. meningitidis. Dr. Duncan speculated that the patient could have had two problems—the teenager could have been sickened briefly by the leftovers and the N. meningitidis infection. But, ultimately, the serious condition that led to his amputation “actually turned out to be unrelated to the food.”

In the intensive care unit, the teen was diagnosed with purpura fulminans due to meningococcemia. This is a rare and severe complication to a blood infection by N. meningitidis, though it can be caused by other bacteria. The condition stems from a maladaptive inflammatory response to a systemic infection, which causes blood clots to form throughout the body, blood vessels in the skin to collapse, and tissue to die. The teen spent nearly a month in intensive care and experienced many complications. He was intubated and briefly had a pacemaker. He had tissue death and gangrene on his arms and legs, which resulted in amputations of both legs below the knees as well as parts of all 10 fingers.

The doctors ended their case record by noting that he wasn’t up to date on his meningococcal vaccine. However, he regained organ function after he was discharged from the hospital. “Overall, he had a relatively good recovery from what was a very severe and acute presentation of meningococcal purpura fulminans,” they concluded.

https://arstechnica.com/?p=1837225