Diagnostic Workup for a 69-Year-Old Male with Night Sweats and Unintentional Weight Loss
The recommended workup for a 69-year-old male with night sweats and unintentional weight loss should include a comprehensive metabolic panel, complete blood count, chest imaging, and consideration of CT scans of chest/abdomen/pelvis due to the high suspicion for malignancy, particularly lymphoma. 1
Initial Laboratory Evaluation
- Complete blood count (CBC) - to evaluate for cytopenias that may suggest bone marrow involvement
- Comprehensive metabolic panel - to assess liver and kidney function
- Thyroid function tests - to rule out hyperthyroidism
- Inflammatory markers - ESR and CRP to detect inflammatory processes
- Tuberculosis testing - PPD or interferon-gamma release assay
- HIV testing - especially important given the age and symptoms
- Fecal occult blood test - to screen for gastrointestinal malignancy 1, 2
Imaging Studies
- Chest radiography - initial screening for pulmonary pathology or mediastinal lymphadenopathy
- CT scan of chest, abdomen, and pelvis - recommended when lymphadenopathy or other concerning features for lymphoma are present 1
- Consider PET-CT - particularly valuable if there is high suspicion for malignancy 1
- Abdominal ultrasonography - may be considered if initial evaluation is unremarkable 2
Disease-Specific Considerations
Malignancy Evaluation
The combination of night sweats and unintentional weight loss in a 69-year-old male is highly concerning for malignancy, particularly lymphoma. These symptoms are classic "B symptoms" associated with lymphoproliferative disorders 1. Age >40 years with these symptoms significantly increases concern for malignancy 1.
Infectious Disease Evaluation
- Tuberculosis should be considered as it classically presents with night sweats, fever, and weight loss 1
- Fungal infections and other chronic infections may present similarly 1
Endocrine Evaluation
- Thyroid function should be assessed as hyperthyroidism can cause both weight loss and night sweats 1, 2
- Diabetes screening with glucose measurement 1
Additional Considerations
If the initial workup is unremarkable:
- Consider bone marrow biopsy if blood counts are abnormal or if lymphoma remains a strong consideration
- Consider sleep study (polysomnography) if sleep disorders are suspected 1
- Consider gastroenterology evaluation for occult gastrointestinal disorders 2, 3
Common Pitfalls to Avoid
Focusing only on malignancy - While malignancy is a serious concern, non-malignant conditions like thyroid disorders, infections, and gastrointestinal diseases are actually more common causes of unintentional weight loss in older adults 2
Overlooking medications - Polypharmacy in older adults can contribute to weight loss and should be reviewed thoroughly 2
Missing social factors - Assess for depression, isolation, and access to food, which can contribute to weight loss in older adults 2
Premature reassurance - In 16-28% of cases, a readily identifiable cause is not found initially. If initial evaluation is unremarkable, a 3-6 month observation period with close monitoring is appropriate rather than immediate reassurance 2
Neglecting chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) - In patients of this age group, CLL/SLL should be considered, as it typically presents in the sixth or seventh decade of life (median age 72) 4
Remember that night sweats and weight loss are non-specific symptoms that warrant thorough investigation, especially in an older adult where the risk of malignancy is higher.