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“It’s happening,” the 58-year-old man said quietly. Dr. Mark Chelmowski looked over to observe his patient. He was leaning forward, elbows on table, head propped up on his hands. Beads of sweat suddenly appeared on the man’s brow. More popped up on his cheeks, then his jaw. Rivulets ran down the contours of his face, then dripped off his chin onto the table. The man’s eyes were closed. He almost seemed asleep. Chelmowski said his name. “Yes, doctor” was the only response the normally chatty man gave. It was as if he were somehow distracted by the profound sweating. The patient’s vital signs were normal. He didn’t have a fever. His blood pressure and heart rate were normal. Throughout the exam, the patient sat quietly sweating. The collar, front and back of his shirt darkened. Then, as abruptly as it started, it was over. He opened his eyes and looked at Chelmowski.

The patient could see the surprise in his doctor’s face. Chelmowski knew about his episodes of sweating — the two of them had been trying to figure them out for the past five months — but he had not yet witnessed one. The first time it happened, the patient was in his car on the way to the gym when suddenly he felt intensely hot. It was a bright July day in the Milwaukee area and seasonably warm. But this heat felt as if it came from inside his body. A vague prickling sensation spread down his face and neck to his chest and back. His heart seemed to speed up and then — pow — he was drenched in sweat. He turned the car around and headed home. He was describing the strange event to his partner when it happened again. And again. Each episode lasted only a couple of minutes, but it was strange. The sweating was so excessive.

After a fourth episode, the patient’s partner insisted they go to the emergency room. He had another bout in front of the E.R. doctor, who immediately admitted him to the hospital. He was worried the patient might be having a heart attack. Profuse sweating often accompanies myocardial infarctions, the doctor told him. But it wasn’t his heart. He was discharged the next day and encouraged to follow up with his primary-care doctor.

Chelmowski had been trying to figure out these strange episodes ever since. He had never seen anything like it, he told the patient after finally witnessing the strange sweating event. And he really wasn’t sure where else to look. When he saw the patient a week after that first episode, his exam was completely unremarkable. So were the tests that the doctor ordered. His thyroid hormones were normal. He didn’t have an infection. His inflammatory markers were not elevated. And he seemed fine. Whatever it was, the doctor figured, it was over. Then, a month later, it happened again: a half day of intense episodes of drenching sweats and strange distraction, one after the other, each lasting only a few minutes. From that point, the episodes recurred every three to five weeks.

A Trip to the Tropics

The pattern made the strange symptom seem even stranger. The patient was in good shape. He ate a healthy diet and exercised regularly. The only medication he took was an acid reducer for his heartburn. He was almost never sick.

Chelmowski spent hours trying to figure out what was going on. The patient had traveled to the tropics earlier that year. Repeated tests for malaria were negative. It wasn’t H.I.V. The doctor referred him to an endocrinologist. Could this be a pheochromocytoma — a usually benign tumor that causes the adrenal glands to produce too much of the fight-or-flight hormones? Carcinoid tumors live in the gut and produce a variety of hormones. One key symptom of this tumor is flushing and sweating. He was tested for these abnormalities along with other hormonal disorders. Nothing. The infectious-disease doctors who saw him couldn’t find an infection. A cardiologist ordered echocardiograms and EKGs. Normal. A portable monitor found no abnormal heart rhythms over the course of 30 days.

Chelmowski looked for cancers. They can often cause odd symptoms like this. But he found nothing. The patient saw a rheumatologist and a neurologist. They didn’t find anything, either. Chelmowski searched the medical literature for possibilities. He did his own version of crowdsourcing — asking every doctor he ran across if they had any patients with these symptoms. No one had any answers.

Chelmowski was stumped and frustrated. What was he missing? He referred the patient to the Mayo Clinic in Rochester, Minn. Maybe they could figure this out. The patient spent two full days in Rochester. He was poked, prodded, imaged, stuck and questioned. Finally, they came up with an answer: Although his testosterone level was in the normal range, perhaps it was less than he was used to. Maybe this was a relative hormonal deficiency akin to a woman’s menopause, a reaction to the natural reduction of sex hormones because of aging. They recommended testosterone-replacement therapy.

The patient was skeptical but applied the testosterone gel as directed. He used it for months. It didn’t help.

Locker-Room Consultation

Chelmowski was beginning to worry that he was never going to figure it out. Early one morning, at his usual spin class, he found himself on a bike next to an old friend, George Morris, who was a neurologist specializing in seizure disorders. Could these weird episodes be seizures? They weren’t like any seizures Chelmowski had ever heard of, but who knows? In the locker room, he approached Morris. “Have you ever heard of seizures characterized by profuse sweating?” he asked. He outlined the patient’s story. Morris nodded his head as he listened. Yes, he had several patients who sweated like this. Chelmowski should send the patient to his clinic to be tested.

A few weeks later the patient went to the epilepsy center at Aurora St. Luke’s Medical Center, where Morris was medical director. A 20-minute electroencephalogram was normal. If these were seizures, Morris told him, there was a good chance that they would show up on the EEG only when he was having one. They arranged for the patient to return before his next expected day of sweating. It took about an hour for the electrodes to be placed onto his head for the EEG. He could almost cover the whole array with a baseball cap. He didn’t usually wear one, but it was better than walking around with a head full of wires for all to see. Every morning a technician would come to his house to download the data. He was supposed to be hooked up for seven days, but when no sweating episodes happened, they gave him another weekend. And finally, his long-awaited day of sweating occurred.

A couple of days later he got a call. These were seizures. They originated on the left side of his brain, just behind the ear, in what is known as the temporal lobe. A seizure is an episode of abnormal brain activity, and the temporal lobe is in close communication with the autonomic nervous system, which can trigger sweating. Days later, he went back to the center to see Morris and start medications to stop the seizures. He asked the doctor why the episodes came every month. Morris just shook his head. Some seizures have this kind of rhythm. They can be any number of days apart, but a 20-to-30-day cycle is the most common. No one is sure why. It took a while for the patient to get on the right medications at the right dose, but once on it, his seizures stopped. He hasn’t had one in nearly five years.

The patient doesn’t know why he started getting seizures at age 58, although he wonders whether it’s linked to a car accident he was in when he was 10 or 11. He was riding in the front seat in the days before seatbelts and smashed his head on the steering wheel. Maybe, Morris told me. That kind of injury can cause seizures many years later. The injured neurons cause abnormalities in surrounding brain cells, which may, eventually, trigger the abnormal activity that results in a seizure. But epilepsy, as recurring seizures are called, often starts in late middle age. Morris attributes it to cerebrovascular disease — what others call ministrokes.

This patient isn’t buying it. He still traces it all back to a head-on collision resulting in a close encounter with a hard plastic steering wheel.

Lisa Sanders, M.D., is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries.” If you have a solved case to share, write her at Lisa.Sandersmdnyt@gmail.com.