am i dying

My Leg Hurts, Do I Have Necrotizing Fasciitis?

Welcome to Am I Dying, a column that hopes to save you from your late-night WebMD spiraling. You can email us your hypochondriac questions at amidying@nymag.com.

The other night I woke up with a dull pain in my calf, and proceeded to freak the F out. I’d gone on a longish run the day before, so I know — I know! — that could be the culprit, but it wasn’t exactly like other shin splint-type pain I’ve had before, and anyway, the internet told me it’s probably necrotizing fasciitis. A.k.a., flesh-eating bacteria. One of the earliest symptoms? Leg pain. I have seen the pictures and I will never be the same. Please help.

To judge you for making the leap from leg pain to flesh-eating bacteria would be insensitive of me, and also hypocritical, given my own Google history, but, good news: that is QUITE a leap — though necrotizing fasciitis has been in the news lately, so I get why it’s on the brain.

True, leg pain (or pain anywhere, really, though necrotizing fasciitis is most common in feet and legs) is one of the symptoms of necrotizing fasciitis, but the context is super important — one’s legs can cramp and hurt from all sorts of things, but if yours hurts beyond what might be expected given your activity or injury, that’s when you might want to worry, says Dr. Angeliki Vouyouka, associate professor of surgery and radiology at the Icahn School of Medicine at Mount Sinai. It’s also very unlikely that an otherwise healthy person can contract necrotizing fasciitis.

“Hhealthy people usually cannot get it,” says Vouyouka. “It has to be someone who has some sort of immunosuppression — someone who has cancer, or is malnourished, or is diabetic. There are a very few circumstances of people contracting it under significant stress, because that also causes immunosuppression, but I’ve never seen that.” Flesh-eating bacteria also require spaces low on oxygen and blood in order to thrive, says Vouyouka — which is why they can thrive in the fasciia, or membranes. But the bacteria are very unlikely to make it to that point in people without compromised immune systems.

Now. Here is how you do contract necrotizing fasciitis, and what to look for if you think you might be at risk. These flesh-eating bacteria technically exist all around us, says Vouyouka, and they can gain entry to the body through a scratch or other injury. From there — if you are immunosuppressed — the bacteria make their way to the membranes, where they begin to rapidly multiply. “They cause this overwhelming infection and basically kill the muscle and the tissue around it. They eat the flesh,” says Vouyouka. “It is a devastating infection.” Generally speaking, necrotizing fasciitis can only be treated via surgery: debriding and excising the dead tissue. Vouyouka estimates that almost half the cases she sees require some degree of amputation.

Necrotizing fasciitis gets worse very quickly, so Vouyouka encourages anyone with potential symptoms to see a doctor (and soon). “Usually the recommendation is if you get an injury, and it starts hurting, and you have any risk factors for immunosuppression, go to the hospital,” she says. “If it looks red, and it’s painful, just go to the ER. If it’s just a plain infection, that most of us will have, it should go away with antibiotics. But if you have one of the risk factors, you should be extra vigilant.”

In cases of necrotizing fasciitis, redness and pain will likely also be accompanied by fever, fatigue, and clear drainage at the site of the injury, Vouyouka says. So if you don’t have any of that, and you recently exercised in a way that could plausibly cause leg pain, or you’ve just got a little scratch that hurts a typical amount, and you’ve got a healthy immune system, you’re probably okay. Necrotizing fasciitis is horrible, but it doesn’t sound like you have it.

My Leg Hurts, Do I Have Necrotizing Fasciitis?