From the Guidelines
Patients presenting with drenching night sweats and unintentional weight loss should undergo comprehensive screening for several serious conditions, particularly lymphoma, tuberculosis, HIV, and other infections, as these symptoms represent classic "B symptoms" that can indicate serious underlying pathology. The initial evaluation should include a complete blood count with differential, comprehensive metabolic panel, inflammatory markers (ESR, CRP), HIV testing, and a chest X-ray 1. Additional testing should include tuberculosis screening with either a tuberculin skin test or interferon-gamma release assay. A CT scan of the chest, abdomen, and pelvis is often warranted to evaluate for lymphadenopathy or occult malignancy, as recommended by the NCCN clinical practice guidelines in oncology 1. If lymphoma is suspected, lymph node biopsy may be necessary, and a diagnostic assessment based solely on fine-needle aspiration biopsy is insufficient except in unusual circumstances when in combination with immunohistochemistry it is judged to be diagnostic of HL by an expert hematopathologist or cytopathologist 1. For patients with risk factors, consider blood cultures for endocarditis, brucellosis testing, or other specific infectious disease workups. Thyroid function tests should be performed to rule out hyperthyroidism. The combination of night sweats severe enough to soak bedclothes and unintentional weight loss (typically defined as >10% of body weight within 6 months) warrants urgent evaluation, as early diagnosis of conditions like lymphoma or tuberculosis significantly improves treatment outcomes and prognosis 1. Key considerations in the workup include:
- Determination of B symptoms (unexplained fevers >38°C, drenching night sweats, or weight loss of >10% of body weight within 6 months of diagnosis) 1
- Physical examination, including all lymphoid regions, spleen, and liver 1
- Standard laboratory tests, including complete blood count, differential, platelets, erythrocyte sedimentation rate (ESR), serum lactate dehydrogenase, albumin, and liver and renal function tests 1
- PET/CT scan (skull base to midthigh or vertex to feet in selected cases) 1
- Diagnostic contrast-enhanced CT (neck, chest, abdomen, and pelvis) 1
From the Research
Screening Recommendations for Drenching Night Sweats and Unintentional Weight Loss
Patients presenting with drenching night sweats and unintentional weight loss require thorough screening to determine the underlying cause of their symptoms. The following are potential screening recommendations:
- Infectious Disease Screening: Patients should be screened for infectious diseases such as tuberculosis, which can cause night sweats and weight loss 2, 3.
- Cancer Screening: Malignancy is a potential cause of night sweats and weight loss, and patients should be screened for various types of cancer 4.
- Cardiovascular Disease Screening: Pulmonary embolism is a potentially fatal disease that can cause night sweats, and patients should be screened for cardiovascular disease 5.
- Gastroesophageal Reflux Disease (GERD) Screening: GERD is a potential cause of night sweats, and patients should be screened for GERD 6.
- HIV Screening: Patients should be screened for HIV infection, which can cause night sweats and weight loss 4, 3.
- Imaging Studies: Imaging studies such as chest radiographs and computed tomographic (CT) scans should be performed to rule out pulmonary embolism, tuberculosis, and other conditions that can cause night sweats and weight loss 5, 4.
- Laboratory Tests: Laboratory tests such as complete blood counts, blood chemistry tests, and urinalyses should be performed to rule out underlying conditions that can cause night sweats and weight loss 4, 2.