A lupus patient on long-term corticosteroids presents with fever. What is the primary concern?

Systemic lupus erythematosus (SLE) is an autoimmune condition that inherently involves immune dysregulation, and long-term corticosteroid therapy further suppresses immune function. Corticosteroids reduce the activity of T lymphocytes, macrophages, and neutrophils, impairing the body's ability to mount an effective response to pathogens. When a lupus patient on chronic corticosteroids presents with fever, the primary concern must be infection due to immunosuppression. The immunosuppressed state means that even common organisms can cause serious, rapidly progressing infections, and the fever may represent a significant infectious emergency rather than a benign finding. While corticosteroids can cause hyperglycemia, hyperglycemia does not typically cause fever. Fever as a direct medication side effect of corticosteroids is not a recognized phenomenon — corticosteroids actually suppress inflammatory and febrile responses. Hypertension is a known long-term side effect of corticosteroids but does not explain fever. The nurse should treat a new fever in an immunosuppressed lupus patient as a potential infection requiring prompt evaluation, blood cultures, and possible empirical antibiotic therapy, prioritizing this concern above all other corticosteroid-related complications.