The horrific viral story went like this: A 19-year-old New England man ate some bad leftovers — chicken, rice, and noodles from a restaurant meal — and ended up in the hospital for nearly a month, fighting for his life and undergoing multiple amputations because of meningococcal disease.
The Massachusetts General Hospital case was the subject of a 2021 New England Journal of Medicine case challenge, in which doctors describe an unusual, sometimes perplexing case for readers, who then try to discern a diagnosis.
In this case, the authors described a young man who had eaten leftovers 20 hours before being hospitalized. He was vomiting, with aches and pains, neck stiffness, and purple splotches all over his body, among other symptoms. He later went into severe septic shock and developed necrosis, the mass death of cells, when blood clots meant oxygen was unable to reach his extremities.
Over the course of his hospital stay, his medical team amputated both his legs below the knees and parts of all 10 fingers.
The case gained attention again recently after YouTuber Bernard Hsu, who makes videos about medical cases under the username Chubbyemu, posted a re-creation of the story last week, discussing at length something doctors only mentioned in passing: the leftovers the patient had eaten. As of Friday, the video had more than 1.4 million views. Media outlets, from USA Today to People Magazine and the New York Post, picked up the case too, running with headlines that suggested his meal may have lead to the amputations.
There was one problem.
“There’s absolutely no history in the medical literature of this kind of bacteria being transmitted by food,” said Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center and medical director of the National Foundation for Infectious Diseases. “It’s baloney.”
For one doctor involved in the New England Journal of Medicine article, the viral stories focusing on leftovers were both surprising and disappointing.
“It was completely irrelevant to this patient’s presentation,” said Dr. Eric Rosenberg, director of the clinical microbiology laboratory at Massachusetts General Hospital, who edited the article.
MGH physicians have been publishing anonymized case records for about a century as an educational opportunity, giving physicians a chance to hone their skills and dig into real-life cases after the fact.
In this case, Rosenberg said, information about the food the patient ate was barely mentioned in passing. Doctors discussing the case never suspected it caused his illness, since Neisseria meningitidis is transmitted from person to person, not through spoiled food.
“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,” he said.
The New England Journal of Medicine article, which did not identify the 19-year-old, did not say that the Neisseria meningitidis bacteria that caused his illness came from the leftovers he ate. Doctors did not specify where the illness came from at all. They did note that a friend of the teen’s also vomited after eating the same leftovers.
That was, Schaffner said, a bit of a red herring and a common part of emergency medicine. Doctors must sort through a mountain of symptoms and medical histories quickly to figure out how best to treat patients. And if someone comes in vomiting, it’s natural to ask about recent meals.
But the ultimate diagnosis in this case was the most severe form of meningococcal disease, fulminant meningococcemia.
Neisseria meningitidis is usually transmitted through close contact: sharing a drink or a cigarette, kissing, eating off the same fork. It can be common in places where people live in close proximity to one another, though vaccines have made it much less prevalent.
Dr. Peter Rice, a professor of medicine at the UMass Chan Medical School’s Infectious Diseases And Immunology Division, said he heard of the case and searched medical literature for documentation of someone contracting bacterial meningitis from food. He found none.
“I think it’s highly unlikely, frankly,” Rice said. “I think it’s probably two unrelated circumstances occurring simultaneously.”
It’s possible that the food had an unrelated contaminant, Rice said, or that some other factor caused the 19-year-old and his friend to vomit after eating it. But it would be incorrect to tie the leftovers to the life-threatening symptoms the man experienced.
“It sounded like the symptoms of the GI [gastrointestinal] upset came almost immediately after eating the food,” Rice said. “And that would be highly unlikely with Neisseria meningitidis, which has an incubation period.”
Neisseria meningitidis, the bacteria that causes meningococcal disease, can live in the back of a person’s throat without causing any illness, Schaffner said.
But if it spreads, Schaffner said, it can penetrate and infect the membranes that surround the brain, known as the meninges, and cause meningitis. It can also get into the bloodstream and cause sepsis.
“This is a devastating infection,” Schaffner said. “And it can be remarkably subtle in its onset.”
One path to prevention, doctors wrote in the NEJM article, is vaccination. The 19-year-old had received only one dose of the meningococcal conjugate vaccine, without a booster, and one dose of the serogroup B meningococcal vaccine. The CDC recommends meningococcal conjugate shots for all children between 11 and 12, with a booster dose around age 16.
It is, of course, possible to get sick after eating contaminated food. But those symptoms will typically look more like stomach upsets than bacterial meningitis.
To prevent food-borne illnesses, the Centers for Disease Control and Prevention recommend keeping perishable foods like meat, seafood, eggs, milk, fruits, vegetables in the fridge or freezer, in environments that do not go above 40 degrees; and heating leftovers to 165 degrees, by which point illness-causing pathogens will have died.
Cooked rice should not be left at room temperature for more than an hour, according to the University of California’s Division of Agriculture and Natural Resources. Keep it below 40 degrees in the fridge, or at above 140 degrees in a rice cooker. Eating cold leftover rice cooked in the last 3 to 5 days is usually safe as long as the food has not spent too long above 40 degrees before being eaten.
The 19-year-old from the MGH case was released from the hospital 26 days after admission.
“Overall, he had a relatively good recovery from what was a very severe and acute presentation of meningococcal purpura fulminans,” Dr. Alexandra Lucas wrote in the New England Journal of Medicine.
Gal Tziperman Lotan is a former Globe staff member.