Can Shingles Cause Night Sweats?
Yes, shingles can cause night sweats, though this is an uncommon manifestation related to autonomic nervous system involvement during varicella-zoster virus (VZV) reactivation.
Mechanism of Night Sweats in Shingles
The underlying mechanism involves damage to the autonomic nervous system when VZV reactivates in autonomic ganglia 1. Here's how this occurs:
Pathophysiology
VZV remains dormant in dorsal root ganglia or sensory ganglia of cranial nerves after primary varicella infection, and reactivation occurs when cellular immune response fails to control latent viral replication 2
Autonomic ganglia involvement: When latent VZV reactivates in autonomic ganglia (rather than just sensory ganglia), it can damage sympathetic nerve fibers that control sweating and other autonomic functions 1
This autonomic dysfunction can manifest as either increased sweating (hyperhidrosis) or decreased sweating (hypohidrosis), depending on which sympathetic nerve pathways are affected 1
Clinical Evidence
A documented case report demonstrated that VZV infection caused unilateral sweating reduction due to sympathetic nerve damage, confirmed by electromyographic skin sympathetic reflex testing 1
Night sweats may represent a systemic response to viral reactivation, particularly during the acute phase when viral shedding peaks in the first 24 hours after lesion onset 3
The autonomic symptoms can occur alongside the classic dermatomal rash and pain, or rarely as part of atypical presentations 4
Risk Factors for Autonomic Involvement
Patients at higher risk for atypical manifestations including autonomic symptoms include:
Immunocompromised individuals: Those with HIV/AIDS (RR 1.53), cancer patients, or those on immunosuppressive therapy have increased risk of disseminated disease and complications 2
Elderly patients: Risk increases to 50% among those aged >85 years, with greater likelihood of atypical presentations 2, 5
Patients with comorbidities: Diabetes mellitus (RR 1.52), systemic lupus erythematosus (RR 2.08), and other conditions that impair cellular immunity 2
Clinical Implications
Night sweats in the context of shingles should prompt evaluation for disseminated disease, particularly if accompanied by multi-dermatomal involvement, visceral symptoms, or constitutional symptoms 3
Immunocompromised patients presenting with night sweats and suspected shingles require immediate intravenous acyclovir 10 mg/kg every 8 hours rather than oral therapy, as they are at high risk for severe complications 3, 6
The presence of autonomic symptoms does not change the fundamental treatment approach: antiviral therapy should be initiated within 72 hours of rash onset and continued until all lesions have completely scabbed 3, 6
Common Pitfall
Do not dismiss night sweats as unrelated to shingles, especially in immunocompromised or elderly patients—this may indicate more extensive autonomic nervous system involvement or systemic viral dissemination requiring escalation to intravenous therapy 3, 1.