Intended for healthcare professionals

Practice Rational Testing

Patients who report night sweats

BMJ 2023; 381 doi: (Published 17 May 2023) Cite this as: BMJ 2023;381:e073982
  1. Jeffrey Larnard, attending physician1,
  2. Jonathan Berry, fellow2,
  3. Priyanka Majety, attending physician3,
  4. Letumile Moeng, fellow1,
  5. Marianne Lille, admission case manager4,
  6. Matthew Shou Lun Lee, attending physician1
  1. 1Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
  2. 2Division of Hematology/Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
  3. 3Division of Endocrinology, Diabetes, and Metabolism, Virginia Commonwealth University, Richmond, VA, USA
  4. 4Department of Nursing, Beth Israel Deaconess Medical Center, Boston, MA, USA
  1. Correspondence to: J Larnard jclarnar{at}

What you need to know

  • Night sweats are commonly reported, with a broad differential including both benign and life threatening causes

  • A detailed history, including characterising and contextualising the night sweats, and physical examination will help guide probability of certain conditions and help focus testing

  • Patients presenting with night sweats who have high risk signs or symptoms and host factors warrant further work-up, including complete blood count, inflammatory markers, and other testing guided by history and physical exam

  • For patients without concerning or high risk features, re-assessment 2-4 weeks after initial presentation before pursuing laboratory evaluation may be appropriate

A 48 year old woman with hypertension presents to her general practitioner reporting night sweats. She has had drenching night sweats every night for the past two weeks and often has to change her shirt in the middle of the night. She also reports she has daily episodes of fever, up to 39°C. Her weight has been stable, but she reports feeling a little more fatigued than usual. She does not have headache, cough, shortness of breath, chest pain, palpitations, abdominal pain, diarrhoea, or dysuria. She was born and resides in the northeast United States and has not travelled recently. Other than a fever up to 38.5°C, her vital signs and physical exam are normal.

Night sweats have historically been poorly defined, but generally can be thought of as excessive sweating that occurs during night time.12 The reason clinicians often ask about “night sweats,” as opposed to “day sweats” is that the threshold to sweat is lower at night.1 Thus, a condition such as tuberculosis that causes intermittent temperature rise would be more likely to lead to sweating at 3 am as opposed to 3 pm.

Night sweats are commonly reported across various settings. In one systematic review, prevalence estimates ranged widely across difference countries, …

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