Cotton fever

Background

• Mimics sepsis in patients who inject drugs and filter those drugs through cotton balls, particularly associated with heroin
• Pantoea agglomerans on the cotton plant releases endotoxins before the plant is processed, which are then injected along with the recreational substance, resulting in a sepsis syndrome without infection

Clinical Manifestations

• Self-resolving fevers, leukocytosis, myalgias, and nausea/vomiting, with negative blood cultures
• Usually within 10 to 30 minutes after injection, and self-limited

Further Reading

• "Cotton fever": A benign febrile syndrome in intravenous drug abusers. J Emerg Med. 1990;8(2):135-139. doi: 10.1016/0736-4679(90)90222-H.