Night Sweats

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of night sweats

Severity is ‍mildmoderatesevere, requiring ‍no change of clothes or beddingchange of clotheschange of bedding

Occurs ‍every night

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍loss of appetite

‍fatigue

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍dyspnea, ‍at reston exertion

‍hemoptysis

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍diarrhea, ‍ episodes ‍per day, ‍

‍changes in bowel habits

‍joint pain

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍lymphadenopathy

‍hematuria



Contributing factors:

‍recent travel to endemic areas

‍unprotected sex

‍similar symptoms in close contacts

‍smoking

‍alcohol use

no history of: ‍tuberculosis, ‍HIV/AIDS, ‍lymphoma, ‍leukemia, ‍cancer, ‍menopause, ‍hyperthyroidism, ‍obstructive sleep apnea

no use of: ‍insulin, ‍hormone replacement therapy, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Breasts: ‍normal, ‍mass, ‍axillary adenopathy

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM





ASSESSMENT:

‍Night sweats due to benign causes ‍likelysuspectedpossible

DDx: idiopathic hyperhidrosis, recent increase in exercise, spicy food consumption, overheated sleeping environment, tuberculosis, HIV, endocarditis, menopause, hyperthyroidism, malignancies, lymphoma, leukemia, medications (e.g. antidepressants, antihypertensives, obstructive sleep apnea, GERD, chronic alcohol use, substance withdrawal (e.g., alcohol, opioids), rheumatologic diseases, neurologic conditions, anxiety, chronic fatigue syndrome, sarcoidosis





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍LFTs, ‍albumin, ‍TSH, ‍cortisol, ‍HIV, ‍ESR, ‍CRP, ‍FSH

- Blood cultures

- Chest X-ray

- Tuberculosis test

Treatments:

- Sleep hygiene education

- Avoidance of alcohol and spicy foods

- Medication trial: ‍

Further care:

- Referral to endocrinologist

- Follow-up in ‍ ‍weeksmonths

- Return if night sweats worsen or losing weight