From the Guidelines
High-dose steroids typically do not directly cause fever, and if a patient develops a fever while on high-dose steroids, it's more likely due to an underlying infection or other condition, which may be masked by the steroids' anti-inflammatory effects. According to a study by Xu et al. 1, the duration of fever was significantly lower in COVID-19 patients who received corticosteroids than patients who did not receive corticosteroids. However, this does not necessarily mean that high-dose steroids cause fever.
If fever occurs while on high-dose steroids:
- Do not immediately discontinue the steroids, as this can be dangerous.
- Seek medical attention promptly for evaluation.
- Undergo a thorough workup for potential infections or other causes of fever.
- Continue the prescribed steroid regimen unless directed otherwise by a healthcare provider. Steroids, particularly at high doses, can suppress the immune system, making patients more susceptible to infections. They can also mask symptoms of infection, including fever, making diagnosis challenging. The absence of fever doesn't necessarily mean there's no infection present.
Some studies, such as the one by Furukawa et al. 1, have shown that corticosteroids can be effective in reducing fever in patients with Kawasaki disease who are resistant to IVIG treatment. However, the optimal steroid regimen is not known, and both pulsed and longer-term steroid therapy remain options.
It's essential to note that the use of corticosteroids in COVID-19 patients is still a topic of debate, and the evidence is not yet conclusive. A study by Lu et al. 1 found that corticosteroids did not reduce the risk of mortality in COVID-19 patients. However, another study by Zou et al. 1 suggested that corticosteroids may be beneficial in reducing the duration of fever and improving oxygen saturation in severe COVID-19 patients.
In general, if a patient develops a fever while on high-dose steroids, it's crucial to seek medical attention promptly and undergo a thorough workup to determine the underlying cause of the fever. Appropriate antimicrobial treatment should be initiated while carefully managing the steroid dose. In some cases, the steroid dose may need to be adjusted or temporarily increased to prevent adrenal crisis while treating the underlying cause of the fever. Always carrying a steroid alert card and informing healthcare providers about steroid use can ensure proper management in case of illness or emergencies.
From the Research
Fever as a Side Effect of High-Dose Corticosteroids
- Fever is not typically considered a side effect of high-dose corticosteroids therapy, but rather, corticosteroids are often used to suppress fever in various conditions, such as systemic lupus erythematosus (SLE) 2.
- In patients with SLE, high-dose corticosteroids can suppress SLE fever, usually within 24 hours 2.
- However, in some cases, fever can develop in patients receiving high-dose corticosteroids, and this is often due to infection rather than the corticosteroid therapy itself 2.
- High-dose alternate day corticosteroids have been used to treat systemic onset juvenile rheumatoid arthritis, with significant improvement in disease activity, including resolution of fever, within a mean of 2.1 months 3.
- Chronic intake of high-dose corticosteroids can be associated with multiple adverse clinical effects, including immunosuppression, which can increase the risk of infection and subsequent fever 4.
- The use of high-dose corticosteroids in patients with dengue fever and thrombocytopenia did not result in a significant increase in platelet count, and there was no mention of fever as a side effect of the treatment 5.
- In patients with high-grade immune checkpoint inhibitor hepatitis, high-dose corticosteroids were associated with a higher incidence of infection and hyperglycemia requiring treatment, but not specifically with fever 6.