Cotton fever is a syndrome that is often associated with intravenous drug use, specifically the use of cotton to filter drugs like heroin. The cause of the condition is believed to be endotoxin shed by the bacteria Enterobacter agglomerans which colonizes cotton plants. A condition very similar to cotton fever was described in the 18th century among cotton-mill workers. The term cotton fever was coined in 1975 after the syndrome was recognized in intravenous drug users.^[1]

The symptoms of cotton fever resemble those of sepsis and patients may be initially misdiagnosed upon admission to a hospital. However sepsis is a serious medical condition which can lead to death, whereas cotton fever, if left alone, will usually resolve itself spontaneously within 12-24 hours. Symptoms usually appear with 10-20 minutes after injection and in addition to fever may include headaches, malaise, chills, nausea and tachycardia. The fever itself usually reaches 38.5 – 40.3°C (101 – 105°F) within the first hour.^[1]