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.
