Early to Pressors, Early to Leave Against Medical Advice - Cotton Fever in IV Drug User

Chandrika, Parul; Hussain, Jaffer; Ghadermarzi, Shadi; Bowling, Mark R.

doi:10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a4854

Cited by 1 publication

(4 citation statements)

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“…Studies related to pneumoconiosis from cotton exposure were excluded. As a result, we found only 13 case reports, one case series, and a single cross-sectional study (Table 4 ) [ 2 - 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Most reported cases are treated with broad-spectrum antibiotics (Table 4 ), which carry adverse risks including Clostridium difficile infections. The use of conservative management with fluids and antipyretics may be sufficient [ 5 , 15 ]. Interestingly, most affected patients tend to leave AMA, making it difficult to determine the most effective treatment and understand the prognosis of the illness.…”

Section: Discussionmentioning

confidence: 99%

“…In retrospect, given our patient’s risk factors and toxic presentation, it is difficult to determine whether these were appropriate or inappropriate management choices. Some patients may present with clinical instability requiring vasopressors [ 10 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to fever, other symptoms include rigors, headache, nausea, vomiting, and myalgia. This may be mistaken for a sepsis-like clinical presentation, resulting in a redundant diagnostic workup, overuse of hospital resources, and prescription of unnecessary treatments [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. We aim to raise more awareness about this disease in the healthcare community by presenting a case of cotton fever in a patient with recent intravenous (IV) methamphetamine use.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Just a Bad Case of Cotton Fever: A Case Report and Literature Review

Geedipally¹,

Karki²,

Shirke³

et al. 2022

Cureus

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Fever is one of the most commonly seen presentations in intravenous drug abusers. "Cotton Fever" is a benign condition, unrecognized among the medical community. It is characterized by a systemic inflammatory response syndrome occurring within minutes of intravenous (IV) drug use. Patients present to tertiary-level care settings with fever, chills, gastrointestinal symptoms, shortness of breath, and chest pain. We present the case of a 46-year-old Caucasian male who presented with lightheadedness, chest pain, and gastrointestinal symptoms after using IV methamphetamine. On physical examination, he was disoriented, tachycardic, and had a fever of 102.8⁰F. He did not have any Osler nodes, Janeway lesions, or splinter hemorrhages. Diagnostics showed leukopenia with neutropenia, lactic acidosis, and elevated creatine kinase. Blood cultures did not grow any organisms. The patient was admitted to the intensive care unit and treated with IV fluids and broad-spectrum antibiotics. His condition improved rapidly and the patient left against medical advice (AMA).The toxic appearance of patients presenting with cotton fever often causes panic among clinicians, resulting in an extensive diagnostic workup, exhaustion of hospital resources, and overprescription of antibiotics. Due to the lack of knowledge about this condition among healthcare practitioners and the tendency of these patients to leave AMA, an appropriate management strategy remains unrecognized. Our case aims to bring awareness about this condition to help guide patient-directed care, reduce the use of healthcare resources, and establish prevention strategies in the community.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%