From the Guidelines
The workup for night sweats in a 50-year-old man should begin with a thorough history and physical examination, including determination of B symptoms, followed by standard laboratory tests, and imaging studies such as PET/CT scan and diagnostic contrast-enhanced CT scan. The history should focus on the duration, severity, and pattern of night sweats, associated symptoms, medication use, recent travel, and risk factors for infections 1. The physical examination should include all lymphoid regions, spleen, and liver, as well as vital signs, heart, lungs, abdomen, and skin. Initial laboratory tests should include complete blood count, comprehensive metabolic panel, erythrocyte sedimentation rate, C-reactive protein, thyroid function tests, and HIV testing 1.
Some key points to consider in the workup include:
- Determining the presence of B symptoms, such as unexplained fevers, drenching night sweats, or weight loss of >10% of body weight within 6 months of diagnosis 1
- Evaluating for infections, malignancies, or other pulmonary conditions with a chest X-ray or CT scan 1
- Considering tuberculosis testing with either a tuberculin skin test or interferon-gamma release assay
- Assessing for endocrine disorders, such as hyperthyroidism, and medications that may be contributing to night sweats
Imaging studies, such as PET/CT scan and diagnostic contrast-enhanced CT scan, are crucial in evaluating for malignancies, such as lymphoma, and other conditions that may be causing night sweats 1. A PET/CT scan is recommended as part of the initial workup, as it has high sensitivity for detecting bone marrow involvement and can help guide further testing and treatment 1.
Common causes of night sweats in middle-aged men include infections (tuberculosis, HIV, endocarditis), malignancies (lymphoma, leukemia), endocrine disorders (hyperthyroidism), medications (antidepressants, antipyretics), and obstructive sleep apnea. Management should target the underlying cause, but symptomatic relief can be provided with moisture-wicking bedding, keeping the bedroom cool, and avoiding alcohol and spicy foods before bedtime.
From the Research
Diagnostic Evaluation for Night Sweats
The diagnostic evaluation for night sweats in a 50-year-old man involves a systematic and cost-conscious approach, as outlined in the study by 2. The initial step is to take a thorough history and perform a physical examination to identify any potential underlying causes.
Common Causes of Night Sweats
Some common causes of night sweats include:
- Menopause
- Mood disorders
- Gastroesophageal reflux disease
- Hyperthyroidism
- Obesity
Laboratory and Imaging Studies
If the initial history and physical examination do not reveal a specific cause, the following laboratory and imaging studies may be considered:
- Complete blood count
- Tuberculosis testing
- Thyroid-stimulating hormone levels
- HIV testing
- C-reactive protein level
- Chest radiography Additional tests that could be considered selectively include:
- Computed tomography of the chest and/or abdomen
- Bone marrow biopsy
- Polysomnography
- Additional laboratory studies if indicated
Inflammatory Markers
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are markers of inflammatory conditions that can be used to help diagnose and monitor inflammatory conditions, as discussed in the study by 3.
Clinical Approach
The study by 2 recommends that if the results of the initial laboratory and imaging studies are normal, and no additional disorders are suspected, reassurance and continued monitoring are recommended. The presence of night sweats alone does not indicate an increased risk of death.
Specific Cases
The studies by 4 and 5 present specific cases of patients with night sweats, highlighting the importance of a thorough diagnostic evaluation to identify any underlying causes. The study by 6 provides a systematic review of the literature on night sweats, discussing the definition, mechanisms, incidence/prevalence, measurement, clinical causes, evaluation, treatment, and prognosis of night sweats.