My Mysterious Case of Cellulitis
Failing to perceive an insect (or centipede) bite, misinterpreting my initial symptoms, finally noticing the signs of lymphangitis. A case study of centipede bite induced cellulitis.
My New Year started off with a curious medical adventure that may be instructive to my readers who spend time in the tropics. My last day on Maui (January 30), I went for a long jog around a meadow near my brother’s house, and then came home and showered and joined some friends for lunch. I felt great until about the moment lunch was served, when I was—in the space of about 2 minutes—overcome with the chills and a general feeling of malaise.
My first thought was that I was dehydrated, as I’d been going for long jogs in the sun every day for ten days while neglecting to drink enough water. On top of that, my main source of water was my brother’s tap, which runs through a reverse osmosis (RO) filter that takes all of the electrolyte out of it.
And so I went back to my brother’s, drank a ton of water with electrolyte powder, took a long nap, then rested, then went to bed early.
The next morning I felt decidedly better, but while I was shaving, the left side of my groin bumped the sink counter, and I flinched with pain. Probing my groin, I detected what I believed to be were swollen lymph nodes, but I wasn’t sure. It occurred to me that maybe — during my vigorous run in the sun up a steep hill while dehydrated—I had pulled an adductor muscle in my groin.
At this point, I made my first amateur mistake: I carefully examined my leg and my foot for signs of a cut, abrasion, or insect bite without thinking to inspect the middle of the back of my calf.
Okay, I thought, so I’ve either got a groin strain or a swollen gland in my groin, but I’m otherwise feeling better, so I’m not going to sweat this.
I felt gradually better all day, but then, as I was about to board my flight back to Dallas at 8:00 pm on New Year’s Eve, I was again overcome with the chills. The long flight back to Dallas was miserable and I didn’t sleep at all.
I got home to my place in Dallas just before 8:00 AM, crawled into bed, and had a fever dream in which I was having a conversation with the lawyer and fellow author, Aaron Siri in which I couldn’t find the words to answer his questions.
The most vivid images of his big, lively brown eyes — staring at me with perplexity and concern — flashed through my dream.
“Are you okay, John?” he asked.
“No,” I replied.
“That’s not good.”
“No, it’s not, but I’m enjoying our conversation nonetheless.”
“Do you think you should see a doctor?” he asked with grave concern.
“Doctors is all swabs,” I said, suddenly quoting Billy Bones in Treasure Island. “What do doctors know about seafaring men like me?”
“I don’t think all doctors are swabs,” Aaron said. “What about Dr. McCullough?”
“He’s a good doctor but he’s skiing — or trying to ski. Or maybe he’s grass skiing. I don’t think there’s any snow in Colorado.”
“Why don’t you try calling him.”
“He’ll probably tell me to get examined by a doctor, and doctors is all swabs.”
I awakened at 2:00 pm, had a cup of coffee, and began to feel better, and even went for a long walk in the sun. I continued to feel better and reckoned that my mysterious malaise must be finally resolving.
The next day I woke up, still feeling better, but it was only then that I noticed a rash on the shin of my left leg. It appeared to be a mild rash without much swelling, and not particularly warm to the touch. However, I again made the amateur mistake of not inspecting the middle of the back of my calf.
Was it contact dermatitis? Surely it wasn’t cellulitis, I thought. My reasoning was that there was no apparent wound on my lower leg to create a causal chain for cellulitis, and that the rash was neither swollen nor warm to the touch. Yet another amateur mistake.
Nevertheless, this was concerning, even though I was generally feeling progressively better. I went out on my balcony to inspect the rash in the direct sunlight, and that’s when I noticed the telltale red streak of lymphangitis.
I traced it with my index finger, and it was only then that I contorted my leg around and finally saw what appeared to the the origin of the problem—a purple splotchy area on the posterior midline of my calf.
God, what a dumbass I am, I thought, and called the Highland Park Emergency Room—an absolutely brilliant medical facility located just south of the independent township of Highland Park, right in the middle of Dallas.
The receptionist told me there was no wait, so I drove to the HP ER, where the excellent doctor on call quickly diagnosed me with cellulitis and got me on an antibiotic IV drip.
My blood test came back normal, with no indications of sepsis. An ultrasound showed I had no blood clot in my left leg, and I was released a couple of hours later with an oral antibiotic prescription.
The next day, as the rash began to clear, I again closely inspected the back of my leg and noticed what may be the fang marks of a centipede. However, if it was indeed a centipede bite, it strikes me as very strange that I didn’t feel the sting on the back of my leg.
Perhaps I did feel it, but in my intense concentration while jogging, I assumed it was from being struck by the sharp blade of some Guinea grass that was growing on the jogging path.
A few takeaways:
The initial chills and malaise were likely from the centipede venom, and not from a secondary bacterial infection.
The swollen lymph nodes in my groin may have been initially activated by the centipede venom.
The cellulitis rash that subsequently appeared two days later was apparently caused by a secondary bacterial (staph of strep) infection that entered through the perforation in the skin made by the centipede bite.
When looking for insect, arachnid, or centipede bites, DON’T FORGET to inspect the BACK of your arms and legs. The critters are very adept at climbing aboard the posterior of your limbs. Of all my mistakes, this was the most amateur.
Even if your initial malaise is resolving and you are feeling much better, don’t ignore a rash that even vaguely resembles cellulitis. Once the infection breaches the lymph nodes and enters your bloodstream, you are in big trouble.
Prompt administration with antibiotics will prevent this disaster from happening. We should all be very grateful for antibiotics. Cellulitis used to kill people all the time.
If you live in Dallas and you have a medical emergency, the Highland Park ER on Lemmon Avenue is a fantastic option, without the bedlam of the ERs at our big hospitals. The clinic accepts medical insurance, though I paid a reasonable cash sum for my treatment because my individual policy has a sky high deductible.
My badly bruised ego at making so many amateur mistakes was salved by the clinic manager, who paid me a special visit in my room to tell me that she is a big fan of my true crime books.
I didn’t ask her if she’d read my most recent book, Vaccines: Mythology, Ideology, and Reality. I never know how that particular book is going to go over with medical professionals.
Thanks everyone for their well wishes!
Certainly happy to hear you finally figured out what was happening John. Whew,,,, that could have been a bad experience. Blessings and thanks for all you do for us.