Differential Diagnosis for 75-year-old Female with Urinary Symptoms
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): The patient's symptoms of dysuria, urgency, frequency, suprapubic pain, and intermittent chills are classic for a UTI. Her recent history of holding urine due to decreased bathroom availability and previous history of UTIs also increase the likelihood of this diagnosis.
Other Likely Diagnoses
- Pyelonephritis: Given the patient's remote history of pyelonephritis and current symptoms of right lower back pain, chills, and urinary symptoms, pyelonephritis is a possible diagnosis. The recent upper respiratory illness could have weakened her immune system, making her more susceptible to infection.
- Ureteral Calculi: Although the patient has a history of ureteral calculi, the absence of symptoms such as severe, colicky pain and nausea makes this diagnosis less likely. However, it is still a possibility, especially if the patient has a history of recurrent kidney stones.
Do Not Miss Diagnoses
- Sepsis: Although less likely, sepsis is a potentially life-threatening condition that can occur if a UTI or pyelonephritis is left untreated. The patient's age, recent illness, and symptoms of chills and back pain make it essential to consider sepsis in the differential diagnosis.
- Obstructive Uropathy: If the patient has a ureteral stone or other obstruction, it could lead to severe consequences, including kidney damage. Although less likely, it is crucial to rule out obstructive uropathy, especially given the patient's history of ureteral calculi.
Rare Diagnoses
- Tuberculosis (TB) of the Urinary Tract: Although rare, TB of the urinary tract could present with similar symptoms, including dysuria, frequency, and back pain. The patient's recent travel to Europe and history of upper respiratory illness make this diagnosis slightly more plausible, but it is still relatively rare.
- Malignancy: Although unlikely, it is essential to consider the possibility of a urinary tract malignancy, such as bladder or kidney cancer, especially in an older adult with a history of recurrent UTIs and ureteral calculi. However, the patient's symptoms are more suggestive of an infectious or obstructive process.