Night sweats

Background

• Also known as sleep hyperhidrosis

Etiologies

• Infectious
  • Tuberculosis
  • HIV
  • Bacterial infections, including endocarditis, osteomyelitis, and abscess
  • Brucella melitensis, if risk factors for zoonotic transmission including unpasteurized dairy
  • Malaria, if compatible travel history
  • Babesia, Ehrlichia, or Anaplasma, if compatible exposure
  • Coccidiomycosis, if compatible travel history
• Neoplastic: lymphoma, solid-organ cancers (particularly prostate cancer, renal cell carcinoma, and germ cell tumour)
• Adverse effect of medications: anticholinergics, antihistamines, antitussives, beta blockers, cholinesterase inhibitors, decongestants, antiandrogens, GNRH, insulin, oral hypoglycemic medications, SERMs, thyroid supplements, methadone, NSAIDs, meperidine, antipyretics, clozapine, SSRIs, TCAs
• Withdrawal from alcohol, opioids, and cocain
• Endocrine: menopause, hyperthyroidism, pheochromocytoma, carcinoid syndrome, insulinoma, acromegaly, central diabetes insipidus, eosinophilic pneumonia
• Neurologic: autonomic dysreflexia, syringomyelia
• Sleep disorders: obstructive sleep apnea
• Inflammatory/autoimmune: giant cell arteritis, chronic granulomatous disease, rheumatoid arthritis, sarcoidosis
• Other: GERD, chronic fatigue syndrome, mercury poisoning,, essential thrombocythemia, anxiety or panic disorder, PTSD

Investigations

• Chest x-ray for TB
• CBC, TSH, HIV, CRP, liver panel, blood cultures, urinalysis
• If persistent and undiagnosed:
  • CT chest/abdo/pelvis; if negative, then
  • Transthoracic echo; if negative, then
  • Bone marrow biopsy; if negative, then
  • 24-hour urine for 5-HIAA, metanephrines, and catecholamines