Differential Diagnosis for a 54-year-old Female with Urinary Symptoms
- Single most likely diagnosis
- Recurrent Urinary Tract Infection (UTI): The patient's symptoms of urgency, frequency, dysuria, and suprapubic pressure are classic for a UTI. Her recent history of a UTI that resolved with nitrofurantoin, followed by the return of similar symptoms, suggests a recurrent infection, possibly due to incomplete eradication of the bacteria or reinfection.
- Other Likely diagnoses
- Interstitial Cystitis: This condition could present with similar symptoms of urgency, frequency, and suprapubic pressure, especially if the patient has a history of recurrent UTIs. However, the absence of other symptoms like pelvic pain and the recent history of UTI make this less likely.
- Overactive Bladder: Symptoms of urgency and frequency could also suggest overactive bladder, but the presence of dysuria and suprapubic pressure points more towards an infectious or inflammatory cause.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pyelonephritis: Although the patient denies back pain and fever, which are common symptoms of pyelonephritis, it's crucial not to miss this diagnosis due to its potential for severe complications, including sepsis and kidney damage. The absence of these symptoms doesn't entirely rule out pyelonephritis, especially in older adults who may present atypically.
- Sepsis: Any infection, including a UTI, can potentially lead to sepsis, a life-threatening condition. While the patient doesn't currently exhibit signs of sepsis like fever, vomiting, or chills, monitoring for these symptoms and being aware of the risk is essential.
- Rare diagnoses
- Bladder Cancer: Although rare, bladder cancer can present with symptoms of urgency, frequency, and dysuria. Given the patient's age and recurrent UTI history, it's essential to consider this in the differential, especially if symptoms persist or recur despite appropriate treatment.
- Tuberculosis of the Urinary Tract: This is a rare condition in many parts of the world but can present with chronic or recurrent urinary symptoms. It would be considered if the patient has risk factors for TB or if standard UTI treatments fail.