Differential Diagnosis for 79-year-old Female with Continued Dysuria and GI Distress
- Single Most Likely Diagnosis
- Cefdinir-induced GI Distress: The patient's symptoms of upper abdominal discomfort, abdominal fullness, and inability to complete her tube feeding started after initiating cefdinir, suggesting a possible adverse reaction to the antibiotic.
- Other Likely Diagnoses
- Pyelonephritis: Although the patient was diagnosed with questionable UTI versus pyelonephritis in the emergency room, her continued symptoms of dysuria and left lower quadrant discomfort could indicate an ongoing or worsening infection.
- Urinary Tract Infection (UTI) with resistant organisms: The patient's culture from her PCP showed multiple bacteria, but no sensitivity was completed, making it possible that the UTI is caused by resistant organisms that are not responding to cefdinir.
- Constipation or Bowel Obstruction: The patient's symptoms of abdominal fullness, discomfort, and inability to complete her tube feeding could also be indicative of constipation or bowel obstruction, especially in the context of her ALS and tube feeding.
- Do Not Miss Diagnoses
- Sepsis: Although the patient denies fever, sepsis is a life-threatening condition that can occur in the context of UTI or pyelonephritis, especially in elderly patients with multiple comorbidities.
- Kidney Stone or Obstruction: The patient's symptoms of dysuria and left lower quadrant discomfort could also be indicative of a kidney stone or obstruction, which would require prompt medical attention.
- Antibiotic-associated Diarrhea or Clostridioides difficile (C. diff) Infection: The patient's GI distress could be indicative of antibiotic-associated diarrhea or C. diff infection, which can be life-threatening if not promptly treated.
- Rare Diagnoses
- Interstitial Cystitis: The patient's symptoms of dysuria and pelvic discomfort could be indicative of interstitial cystitis, a rare condition characterized by chronic inflammation of the bladder.
- Tuberculosis (TB) of the Urinary Tract: Although rare, TB of the urinary tract could present with symptoms similar to those experienced by the patient, including dysuria and abdominal discomfort.