One sip of a vodka tonic landed a 35-year-old woman in the emergency room, and seven years later, she's still dealing with the damage caused by the drink, according to a new report of her case. 
 
 The woman had a rare condition called "quinine-induced thrombotic microangiopathy," which caused a body-wide reaction to quinine, a chemical found in tonic water, the doctors who treated her wrote in the case report, published today (Jan. 4) in The New England Journal of Medicine. 
 
 The illness "hit like lightning," said Dr. James George, a hematologist at the University of Oklahoma and the lead author of the report. [Here's a Giant List of the Strangest Medical Cases We've Covered] 
 
 At the time of the incident in 2009, the woman told doctors that she had suddenly become ill when driving home from an office party. She developed chills, muscle aches, nausea and abdominal cramps, the doctors wrote. 
 
 That night, she ran a fever of 102 degrees Fahrenheit (38.9 degrees Celcius), and her stomach problems persisted. But by the time she went to the emergency room the next morning, her symptoms had improved. At the time, the ER doctors suspected that the woman had viral gastroenteritis — the stomach flu. 
 
 But the woman returned to the ER two days later; she still had back pain and had not urinated since she got sick, according to the case report. This time, she was admitted to the hospital, where tests showed that she had experienced kidney damage, according to the report. 
 
 The doctors suspected that the woman had thrombotic microangiopathy (TMA), which occurs when blood clots form in the tiny vessels in the body and can be caused by a range of factors, George said. 
 
 In her case, however, the cause of TMA wasn't one that doctors often see, such as problems with blood-clotting mechanisms or a particular type of E. coli infection, George said. 
 
 Quinine, the chemical found in tonic water, can also cause TMA, but George said the woman told him that she didn't take quinine pills or drink gin and tonics. (The Food and Drug Administration banned quinine pills in 2007 because of severe reactions linked to them.) 
 
 It was only then that the woman recalled having a sip of a vodka tonic at her office holiday party the night she got sick, George said. 
 
 In addition, she also realized that she had a similar reaction 16 months earlier, when she drank a vodka tonic at a wedding and also had to go to the hospital, according to the report. That time, however, her major symptom was a severe headache, the doctors wrote. 
 
 When a person has quinine-induced TMA, he or she has a particular type of "auto-antibody" in the blood, George told Live Science. Auto-antibodies, which are found in people with autoimmune disease, attack the body as if it were a "foreign" invader. 
 
 Normally, these particular auto-antibodies are not very active in the body, George said. 
 
 But when the person ingests quinine, the chemical binds to these auto-antibodies and causes them to change their shape, George said. In their new shape, they're able to attack cells in the body aggressively, inflicting serious damage, he said. Once the quinine is cleared from the body, the auto-antibodies return to their harmless state, he added; only the damage to the body is left. [The 16 Strangest Medical Cases of 2016] 
 
 "It's like a tornado going through town, and then you spend a month cleaning up," George said. 
 
 Indeed, George noted that it was likely that by the time the woman had gone to the emergency room, the quinine had already left her body. However, the auto-antibodies had enough time to do severe damage to her kidneys, in particular, he said. The kidneys are particularly vulnerable to damage from TMA because they have an abundance of very small and delicate blood vessels, he added. 
 
 The woman was the 19th patient that George had seen with quinine-induced TMA over a 15-year period, he said. For someone to have a reaction this severe to the concentration of quinine in tonic water, he or she would have to be extremely sensitive to the chemical, he said. 
 
 Currently, there is no specific treatment for quinine-induced TMA, George said. The woman did spend about a week in the hospital, but during this time, she was not acutely ill, he said. Because of the damage to her kidneys, she had to undergo dialysis for two months, according to the report. 
 
 At a recent follow-up visit seven years later, the woman told doctors that she was doing well and was able to fulfill her responsibilities with her family and her career. She is taking medications for her kidneys, and she often has trouble thinking of "particular words during conversations and [had] to stop in the middle of her sentences to 'wait for [her] brain to catch up,'" she said, according to the report. The damage from the auto-antibodies also might have affected some of the small blood vessels in her brain, George noted. 
 
 Originally published on Live Science. ||||| Abstract 
 
 Case presentation: A 35 year old white female was in excellent health until the sudden onset of fever, chills, headache, myalgias, abdominal and flank pain, nausea and vomiting while driving home from a banquet. She went to an ER the following day; her hematocrit was 39% and platelet count 132,000/µL. She was given IV fluids, antiemetics, and sent home. Two days later, she returned to the ER as her symptoms persisted and she had not urinated since they began; her hematocrit was 32%, platelet count 54,000/µL, creatinine 9.3 mg/dL, AST 350, ALT 274, LDH 2402. Due to anemia, thrombocytopenia, and acute kidney injury (AKI), plasma exchange (PEX) was begun because of suspicion of thrombotic thrombocytopenic purpura; Shiga toxin-induced hemolytic uremic syndrome was also considered. Hemodialysis was begun as her creatinine rose to 10.5 mg/dL and anuria persisted. We saw her the following day; drug-induced TMA was considered to be the most likely etiology because of the very sudden, severe onset with anuric AKI. However her only medicine was Singulair for asthma, which she had taken daily for several years. She had never taken quinine tablets or drunk gin and tonic; then she asked us, "What about vodka and tonic?". She had had "a sip" of vodka and tonic at the banquet; it was a favorite drink. Her previous vodka and tonic was 16 months previously; she had then developed sudden severe headache, neck pain, fever and chills causing suspicion of meningitis. Head CT scan and spinal fluid were normal; blood counts remained normal; creatinine increased transiently to 1.7; an association with vodka and tonic was not suspected. This history confirmed the quinine etiology of her TMA. Subsequently she was demonstrated to have quinine-dependent antibodies reactive with platelets and neutrophils (BloodCenter of Wisconsin). Genetic sequencing (U of Iowa) revealed no mutations associated with complement-mediated TMA. PEX was continued until her platelet count was normal (12 days); hemodialysis was required for 2 months. Five years after TMA, she continues to have hypertension, fatigue and arthralgias. Her creatinine clearance is 54 ml/min/1.73m2, indicating Stage 3A chronic kidney disease. 
 
 Systematic literature review: A search of 12 databases for reports of adverse reactions to quinine identified 118 patients with definite or probable evidence for a causal association of quinine with idiosyncratic adverse reactions. Most quinine reactions were related to ingestion of tablets, but 24 patients had adverse reactions caused by quinine-containing beverages. Three patients had TMA, similar to our patient; 2 of these 3 patients also had disseminated intravascular coagulation (DIC); one also had liver function abnormalities. Seven patients had isolated severe thrombocytopenia, 1 patient had granulomatous hepatitis, 1 patient had retina toxicity with vision loss; 1 patient had anaphylaxis, and 11 patients had cutaneous reactions (Table). Many patients had multiple recurrent episodes before the quinine etiology was discovered. All patients recovered, but no reports described long-term follow-up. 
 
 Conclusion: Our patient's experience and our review published reports highlight the potential for severe, systemic adverse reactions caused by quinine-containing beverages. The reactions may involve multiple organ systems. Long-term outcomes are not described in published reports, but our patient has chronic kidney disease 5 years following her acute TMA. The small amounts of quinine in beverages (typically 80 mg/l) are sufficient to cause severe immunologic adverse reactions. Quinine is also added to cocktails to create fluorescence, then described as "Shocktails". A thorough history for exposure to quinine is critical. 
 
 24 previously published patients with acute quinine-induced reactions 
 
 Patients Adverse Events 1 TMA (3 episodes), also DIC 1 TMA (6 episodes), also fever, chills, neutropenia, DIC, liver function abnormalities 1 TMA (1 episode) 7 Thrombocytopenia (3 patients, multiple episodes), nadir platelet count (median) 2000/µL 1 Granulomatous hepatitis, neutropenia (multiple episodes) 1 Retinal toxicity, vision loss 1 Anaphylactic shock (2 episodes) 11 Dermatologic disorders: fixed drug eruptions (7), toxic epidermal necrolysis (1), urticaria (1), photosensitivity, erythematous lesions (1), erythematosus rash (1) Table. ||||| While driving home from a party, a 35-year-old previously healthy woman had a sudden onset of chills, myalgias, nausea, and abdominal cramping. That night fever, explosive nonbloody diarrhea, frequent vomiting, and abdominal and low back pain developed. 
 
 Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. 
 
 Dr. Nester reports receiving fees for consulting and serving on an advisory board from Achillion Pharmaceuticals. No other potential conflict of interest relevant to this article was reported. ||||| We've ingested many hard-to-pronounce ingredients in our lives, and quinine is definitely one of them. Pronounced kwahy-nahyn, this bitter alkaloid isn't one of those suspicious, scary ingredients lurking in your favorite gummy candies -- actually, we have quinine to thank for our favorite cocktail, the gin and tonic (among other things). 
 
 Quinine was originally used as a malaria treatment during the days of colonial India. Naturally found in the bark of the cinchona tree found in the Peruvian Andes, one legend of its discovery claims that a South American Indian suffering from malaria took a drink from a pool of water contaminated with cinchona tree and it cured his fever. Regardless of exactly how it was discovered, the first documentation of its use as malaria is recorded in 1630 in Peru. It continued to be used for its antimalarial properties until the 1920s, when other drugs with fewer side effects took its place, like chloroquine. That's almost 300 years of use. And somewhere along the way, quinine found its way into our cocktails. 
 
 We spoke to Jordan Silbert -- founder of the fancy soda and tonic company, Q Drinks -- and here's how he recounts quinine's transition from treatment to cocktail: 
 
 In 1825 clever -- or drunk, depending on how you look at it -- British officers in the Indian Army improved this bitter medicine by mixing it with soda water, sugar, and gin. Instead of drinking the medicine with their troops at dawn, the officers figured out how to enjoy it at cocktail hour. The original gin and tonic was born, and it soon became the quintessential drink of the British Empire. 
 
 Today, quinine is rarely used for medicinal purposes. The FDA recently banned its use as a cure for leg cramps due to the negative side effects that can result from ingesting large amounts, such as headaches and fever. Some bad reactions to quinine have even been fatal. 
 
 Scary, we know. But don't let that deter you from ordering a gin and tonic next time you're at the bar, because tonic water contains very low levels of quinine. A glass of tonic water holds roughly 20 mg of quinine, whereas a dose for the treatment of leg cramps would be in the 200 to 300 mg range. 
 
 What you should do instead is find a bar near you that has a black light and order yourself a tonic cocktail to revel in its beautiful, iridescent blue glow thanks to its fluorescence quantum yield. (You'll have to look that one up.) That's right folks, not only does quinine treat malaria, but it knows how to party, too. 
 
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– This wasn't your usual hangover. A single sip of a vodka tonic at an office party led to seven years (and counting) of kidney problems for one woman. The cocktail sent the 35-year-old to the emergency room with a mysterious affliction. It would be days before doctors realized the source of her illness was quinine-induced thrombotic microangiopathy (TMA) caused by the tonic water in her drink. Dr. James George, the lead author of a case report published Wednesday in the New England Journal of Medicine, tells Live Science the doctors were initially baffled by the affliction, which "hit like lighting." After the 2009 party, the woman suffered cramps, chills, nausea, and a fever. After three days of being unable to urinate, tests showed kidney damage and it appeared TMA was the cause. But the usual sources of TMA, which happens when blood clots form in one's capillaries, were not there. Then the woman remembered the cocktail, and falling ill 16 months prior after sipping a vodka tonic. Quinine-induced TMA is rare: A 2015 report on her case in Blood explained a search for patients sickened by quinine turned up just 118. In these infrequent cases, quinine triggers an auto-antibody in the blood that attacks the body. Even after the quinine is gone, the damage remains. George says his patient underwent kidney dialysis for two months, and the Blood report described her as experiencing hypertension, fatigue, joint pain, and Stage 3A chronic kidney disease five years later. She continues to take kidney meds. (Quinine made this list of 11 anti-aphrodisiac foods.)