A Rare Case of Steroid-Induced Hypothermia in a Patient With Systemic Lupus Erythematosus

A 75-year-old woman with a history of systemic lupus erythematosus (SLE) presented with isolate ocular symptoms, including a left scleral hematoma, elevated erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Initial evaluation combined with isolated ocular symptoms raised concerns for giant cell arteritis rather than an SLE flare. Thus, prompt initiation of high-dose intravenous methylprednisolone (250 mg every six hours) was warranted. While on treatment, the patient developed hypothermia (33.4 ^oC), detected via routine vitals monitoring for hospitalized patients, four days after starting steroids, which resolved spontaneously without intervention. This case reports a rare occurrence of steroid-induced hypothermia in a patient with SLE receiving high-dose glucocorticoids. The underlying mechanisms remain unclear but may involve hypothalamic interference, immune dysregulation, or endothelial dysfunction inherent to SLE, compounded by glucocorticoid-induced antipyretic effects. Unlike previously reported cases, the patient presented with isolated ocular symptoms and received a higher cumulative steroid dose. This case highlights the need for clinicians to recognize hypothermia as a potential adverse effect of high-dose corticosteroids in SLE, even in atypical presentations. Increased awareness, proactive monitoring, and further research into other risk factors that may predispose patients to developing hypothermia are essential to understanding and managing this rare complication.