Fever on drug-free day of alternate-day steroid therapy

A patient is described who had high spiking fever following a changeover from daily to alternate-day prednisone therapy. No infectious cause was found, and antibiotic therapy did not affect the temperature graph. Previously, the patient, who had dermatomyositis, experienced minimal or no temperature elevation during observation in the hospital, first while receiving no therapy, and later while receiving daily prednisone therapy. Fever disappeared promptly when daily prednisone therapy was resumed. It is postulated that the 12- to 24-hour "drugless" period experienced by a patient during alternate-day prednisone therapy could lead to a withdrawal syndrome characterized by a tertian malaria-like temperature pattern. The importance of recognizing such a phenomenon and distinguishing it from infection is emphasized.