QUIZ: Why so sweaty? *solved*

Sunday, 08 November 2009 18:03

Case description: 35-years old male complains about increased perspiration... it is so intensive, that the bed is all wet after a night's sleep, and during the day the patient has to change his clothes several times.The increased perspiration lasts for about 6 hours, with different periods of normal perspiration in between, lasting from 2 days up to 2 weeks.

QUIZ question: What might be wrong with the patient and how would you treat him?

P.S. This is a case I've heard from a doctor, during a lecture. The final diagnosis surprised me very much and I would like to share this case with you.

Write which diseases can manifest themselves like that and which lab-tests would be helpful. I can't give you the results from the tests because I didn't have a personal contact with this case. I can only say that the patient was diagnosed for a very long time and the tests result were regular, without aberrations... only one test finally confirmed the diagnosis (I admire the doctor who recognised this disease!). I additionally say, that this disease is quite common but the form in which it manifested itself is unusual.

Comments

0 #1 cat_anonim 2009-11-09 17:48

Do we know anything else about the patient?
When did he start having those symptoms?
What is his BP?
His pulse?
Was an ECG made?

Something vaguely crossed my mind, but it's too early to tell what it is ;-)

0 #2 aniamos 2009-11-09 18:44

ECG didn't show any anomalies, the patient doesn't have a hypertension, the pulse is normal.
He's been having this condition for a couple of years now.

0 #3 aniamos 2009-11-09 19:04

cat_anonim - go ahead, write what's boggling you :-)
Half a kingdom to the one who guesses it. This should be called a riddle rather than "a case".

I'll post a solution on 11.11 before 11.11 p.,. ;-)

HALF A KINGDOM FOR THE ONE WHO GUESSES!

0 #4 cat_anonim 2009-11-09 19:36

I was thinking about paroxysmal supraventricula r tachycardia, but after careful consideration it's not it.

I heard this "the bed is all wet after a night's sleep, and during the day the patient has to change his clothes several times" and this won't let me be.

0 #5 Ewelina 2009-11-09 20:31

Was there a throat swab done? Perhaps it's a fungi infection, apparently it causes a lot of unspecific symptoms.

0 #6 aniamos 2009-11-09 20:59

cat_anonim:
the tachycardia would give additional symptoms e.g. palpitation, or dizziness and above all, changes in ECG, but the ECG, even during the sweating period doesn't show anything.
I've also heard such description but regarding another disease (who can remember which one?;-)

Ewelina: honestly I can't tell weather a throat swab was taken, but the sweating is not caused by fungi infection

Do continue, it's mainly a fun game :-)

0 #7 cat_anonim 2009-11-09 21:01

Second idea, endocrine secretion disorder.

0 #8 Qba 2009-11-09 21:15

Hello everybody,

It's my first attempt, the portal caught my attention, I hope it will be constantly developing.

As for the case - my guess is: Hodgkin's lymphoma

0 #9 cat_anonim 2009-11-09 21:40

The occurrence of Hodgkin's lymphoma is about 2-3/100 000. The case description states that it is something common, in an atypical form.

Can you tell us more as to what made you choose this disease? :-)

0 #10 Qba 2009-11-09 21:51

The symptoms, I'm curious as to what the author had in mind.

0 #11 cat_anonim 2009-11-09 22:09

:-)

Out of the given symptoms I'm not seeing a single one related with Hodgkin's lymphoma
There is no mention of enlarged lymph nodes, no fever, nothing present in the pleura nor esophagus. Hence my question, which symptoms made you think about it? :-)

0 #12 aniamos 2009-11-09 22:19

Good thinking, but the cause is different.

In Hodgkin's lymphoma 95% of the patients have enlarged lymph nodes (painless, can hurt after alcohol intake) additional symptoms include: fever, loss of weight, fatigue, hepatomegaly and other things.
I could be a atypical case with sweating being the only symptoms.. but, the important thing here is that the sweating is periodic, the condition appears, then disappears for a shorter or longer period of time. That's the key.

0 #13 cat_anonim 2009-11-09 22:23

I can think of increased temperature and, what follows , increased sweating, but why.

0 #14 MMader 2009-11-09 23:16

The sweating at night could accompany an obstructive sleep apnoea, but we wouldn't have such discontinuity and we shouldn't have such symptom, plus the patient would appear very weakened from the start...

0 #15 Qba 2009-11-09 23:30

cat_anonim - I'll follow your endocrine lead.
How are TSH and fT4 levels? But as the author stated, the patient is being diagnosed for a long time now and they've probably been done in the beginning, but there's nothing wrong in double checking.
Is the patient complaining of something else? Is the sweating accompanied by fever?

0 #16 Michał 2009-11-10 09:00

Since we're talking about hormones, was a kidney USG done, with an emphasis on the adrenal glands?

Was a Mantoux test done?

0 #17 MMader 2009-11-10 12:27

I think we should do a chest X-ray, because sweating at night could be a symptom of tuberculosis.
TB could cause no symptoms that would alert the patient, the sub-feverish state as well as general weakness could be omitted - who isn't generally weakened these days?

0 #18 rotcod 2009-11-10 13:43

Malaria?

0 #19 aniamos 2009-11-10 14:47

The thyroid is a-ok, any thyroid and endocrine disorders are ruled out. TB was also suspected, but ruled out. Malaria could cause intense sweating, but the patient never travelled outside of Europe, besides in Malaria we have lots of other symptoms, recurrent fever mainly, the sweating is present in the final stage of the disease, so the patient would fall into coma before the diagnosis would be made..
If I remember correctly the whole diagnostic process started a couple of years ago