Cotton fever and pregnancy. A confusing clinical problem

Area of Science:

• Obstetrics and Gynecology
• Toxicology
• Infectious Diseases

Background:

• Opioid use disorder (OUD) in pregnancy presents unique diagnostic challenges.
• Intravenous drug use, even with filtration, carries risks of non-infectious complications.
• Pregnant individuals with OUD require careful consideration of diverse etiologies for acute symptoms.

Observation:

• A 24-year-old pregnant woman (33-34 weeks gestation) presented with fever, nausea, vomiting, chills, headache, myalgias, polyarthralgias, severe abdominal pain, and contractions after intravenous Talwin use.
• Initial laboratory workup excluded common obstetric and infectious causes like chorioamnionitis, placental abruption, and endocarditis.
• The patient's symptoms resolved after supportive care, with the key history being filtration of Talwin via a cotton ball.

Findings:

• The clinical presentation and exclusion of other diagnoses strongly suggested "cotton fever."
• Cotton fever is attributed to contaminants or pyrogenic substances introduced from cotton filters during intravenous drug preparation.
• This case highlights a non-infectious, toxin-mediated illness mimicking obstetric emergencies.

Implications:

• Recognizing cotton fever is vital for accurate diagnosis and management in pregnant individuals with a history of intravenous drug use.
• It underscores the need for comprehensive patient history and consideration of less common drug-related complications.
• Early identification prevents unnecessary interventions and guides appropriate supportive care, improving outcomes for mother and fetus.