What is the diagnosis for a 52-year-old male patient with a history of nephropathy, presenting with sharp lumbar pain, dysuria, macroscopic hematuria, polyuria, urethral discharge, genital pruritus, and a history of genital ulcer, now experiencing epigastric pruritus, abdominal pain, asthenia, and exertional dyspnea?

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Diagnóstico Diferencial El paciente presenta un cuadro clínico complejo con síntomas que involucran múltiples sistemas, incluyendo el genitourinario, el gastrointestinal y el cardiovascular. A continuación, se presentan las posibles diagnósticos organizados en categorías:

  • Diagnóstico más probable
  • Infección urinaria complicada: El dolor lumbar, la disuria, la hematuria macroscópica y la poliuria sugieren una infección del tracto urinario. La presencia de exudado uretral blanquecino y prurito genital también apuntan hacia una infección de transmisión sexual, como la uretritis o la prostatitis.
  • Otros diagnósticos probables
  • Nefropatía crónica: El antecedente de nefropatía no especificada y la presencia de hematuria y proteinuria sugieren una enfermedad renal subyacente.
  • Infección de transmisión sexual: La presencia de exudado uretral blanquecino, prurito genital y pápula en el pene sugieren una infección de transmisión sexual, como la gonorrea o la sífilis.
  • Prostatitis crónica: El dolor lumbar, la disuria y la hematuria macroscópica pueden ser síntomas de prostatitis crónica.
  • No debes perder de vista (diagnósticos que no son tan probables, pero que serían mortales si se pierden)
  • Sepsis: La presencia de astenia, disnea de esfuerzo y dolor abdominal puede ser un indicio de sepsis, especialmente si la infección urinaria complicada no se trata adecuadamente.
  • Cáncer de vejiga o riñón: La hematuria macroscópica y la presencia de dolor lumbar pueden ser síntomas de un tumor maligno en el tracto urinario.
  • Diagnósticos raros
  • Sífilis terciaria: La presencia de úlcera genital previa y la aparición de pápula en el pene pueden ser síntomas de sífilis terciaria, aunque es una enfermedad rara en la actualidad.
  • Enfermedad de Behçet: La presencia de úlcera genital y la aparición de pápula en el pene pueden ser síntomas de enfermedad de Behçet, aunque es una enfermedad rara y multifactorial.

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