Determining the Cause
Chief Complaint: Cough
a. History: Night Sweats, Low-grade fever, Weight loss (This is highly sugesstive of tuberculosis, start antibiotic therapy
)
Differential Diagnosis
Tuberculosis, lung abscess) or rheumatic disease?
| Pivotal Assessment | Finding |
|---|---|
Tuberculin Skin Test |
**Other respiratory infections**
- Pneumonia
- Lung abscess
- Fungal infections like histoplasmosis or coccidioidomycosis[1]
**HIV/AIDS**
HIV infection can cause night sweats, with or without cough, due to:
- The virus itself
- Opportunistic infections like Pneumocystis pneumonia
- AIDS-related lymphoma[1]
**Endocarditis**
Infectious endocarditis can present with night sweats and may be accompanied by cough if there are septic pulmonary emboli[1].
## Malignancies
**Lymphoma**
Both Hodgkin's and non-Hodgkin's lymphoma can cause night sweats. Cough may occur if there is mediastinal involvement[1][2].
**Lung cancer**
Can present with persistent cough and night sweats, especially in advanced stages.
## Endocrine Disorders
**Hyperthyroidism**
Can cause excessive sweating and occasionally cough due to goiter compression[2][4].
## Respiratory Disorders
**Obstructive Sleep Apnea**
Associated with night sweats in some patients. The intermittent hypoxia can lead to coughing[2].
**Gastroesophageal Reflux Disease (GERD)**
Can cause both night sweats and chronic cough, especially nocturnal cough[2].
## Other Considerations
- Medications (e.g., certain antidepressants, hormone therapies)
- Menopause (vasomotor symptoms)
- Anxiety disorders[2][4]
## Evaluation
The diagnostic approach should include:
- Detailed history and physical examination
- Complete blood count
- Chest X-ray
- Tuberculosis testing (PPD or interferon-gamma release assay)
- HIV testing if risk factors present
- Thyroid function tests
- Consider CT chest if initial workup is negative and symptoms persist[1][2]
If the initial evaluation is unrevealing and symptoms are not severe, it's reasonable to reassure the patient and monitor clinically, as many cases of night sweats are benign or self-limiting[2].
Citations:
[1] https://www.aafp.org/pubs/afp/issues/2003/0301/p1019.html
[2] https://www.aafp.org/pubs/afp/issues/2020/1001/p427.html
[3] https://www.ncbi.nlm.nih.gov/books/NBK324/
[4] https://www.healthline.com/health/night-sweats
[5] https://www.webmd.com/a-to-z-guides/ss/slideshow-night-sweats
[6] https://www.mayoclinic.org/symptoms/night-sweats/basics/causes/sym-20050768
[7] https://www.ncbi.nlm.nih.gov/books/NBK532273/
[8] https://www.osmosis.org/answers/night-sweats