Night Sweats

1. See Also
   1. Hot Flashes
   2. Hyperhidrosis
   3. Fever
2. Causes
   1. Malignancy (e.g. Lymphoma or Leukemia)
   2. Rheumatologic condition (Temporal Arteritis)
   3. Infection
      1. HIV Infection
      2. Tuberculosis
      3. Infectious Mononucleosis
      4. Fungal infection (Histoplasmosis, Coccidioidomycosis)
      5. Endocarditis
      6. Lung Abscess
   4. Endocrinopathy
      1. Menopause (See Hot Flashes)
      2. Hyperthyroidism
      3. Diabetes Mellitus
      4. Diabetes Insipidus
      5. Carcinoid
      6. Pheochromocytoma
   5. Medications
      1. Acetaminophen
      2. Aspirin
      3. Antihypertensives
      4. Phenothiazines
      5. Niacin
      6. Leuprolide (Lupron)
      7. Tamoxifen
      8. Protease Inhibitors (Indinavir, Saquinavir)
      9. Monoclonal Antibody (Daclizumab, Rituximab)
      10. Antineoplastics (Interferon alfa-2a, Pegaspargase)
   6. Drugs of abuse
      1. Alcohol Abuse
      2. Heroin
   7. Miscellaneous Causes
      1. Sleep Apnea
      2. Gastroesophageal Reflux (GERD)
      3. Anxiety
      4. Pregnancy
3. History
   1. Infectious disease exposure (HIV, Tuberculosis)
   2. Travel (Coccidioidomycosis, Malaria)
   3. Full Review of Systems for comorbid conditions
      1. Evaluate for causes below
4. Exam: Focused on suspected causes
   1. Temperature
   2. Blood Pressure
   3. Thyromegaly
   4. Lymphadenopathy
   5. Splenomegaly
5. Evaluation
   1. Step 1
      1. Evaluate for causes suggested by history and exam
   2. Step 2
      1. Complete Blood Count (CBC)
      2. Chest XRay
      3. Purified Protein Derivative (PPD)
   3. Step 3
      1. HIV Test
      2. Erythrocyte Sedimentation Rate (ESR)
   4. Step 4: Gastroesophageal Reflux Empiric Mangement
      1. Proton Pump Inhibitor trial
   5. Step 5: Chart for nocturnal fever spikes
      1. Obtain Blood Cultures if positive
      2. Include atypical organisms
         1. Haemophilus
         2. Actinobacillus
         3. Cardiobacterium
         4. Eikenella
         5. Kingella
   6. Step 6
      1. Chest CT
      2. Abdominal CT
      3. Bone Marrow Biopsy
   7. Other tests to consider
      1. Follicle Stimulating Hormone (FSH)
         1. Early menopausal symptoms suspected
   8. References
      1. Vera (2003) Am Fam Physician 67(5):1019-24
6. References
   1. Smetana (1993) JAMA 270:2502-3
   2. Vera (2003) Am Fam Physician 67(5):1019-24