Differential Diagnosis
- Single most likely diagnosis
- C) Fitz-Hugh-Curtis syndrome: This diagnosis is the most likely due to the patient's symptoms of severe right upper quadrant pain, fever, and recent diagnosis of pelvic inflammatory disease (PID). The positive nucleic acid amplification testing for Chlamydia trachomatis also supports this diagnosis, as Fitz-Hugh-Curtis syndrome is a known complication of chlamydial infection. The patient's initial improvement with ceftriaxone treatment, followed by worsening symptoms, is also consistent with this diagnosis.
- Other Likely diagnoses
- B) Cholecystitis: Although the patient's symptoms and laboratory results could be consistent with cholecystitis, the recent diagnosis of PID and positive testing for Chlamydia trachomatis make Fitz-Hugh-Curtis syndrome a more likely diagnosis. However, cholecystitis is still a possible diagnosis and should be considered.
- A) Chlamydial cervicitis: While the patient has a positive test for Chlamydia trachomatis, the symptoms of severe right upper quadrant pain and fever are not typical of cervicitis alone. However, chlamydial cervicitis could be a contributing factor to the patient's overall condition.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Perforated viscus or appendicitis: Although the patient's symptoms and laboratory results do not strongly suggest a perforated viscus or appendicitis, these conditions can be life-threatening if missed. The absence of rebound or guarding on physical examination makes these diagnoses less likely, but they should still be considered.
- Septic shock or severe sepsis: The patient's fever, tachycardia, and elevated leukocyte count could be indicative of septic shock or severe sepsis, which are life-threatening conditions that require prompt treatment.
- Rare diagnoses
- D) Hepatitis C infection: The patient's laboratory results show elevated liver enzymes, but the clinical presentation and other laboratory results do not strongly suggest hepatitis C infection. This diagnosis is unlikely, but could be considered if other diagnoses are ruled out.
- Other rare infections or conditions: Such as liver abscess, hepatic infarction, or other rare infections, which could be considered if the patient's symptoms and laboratory results do not match the more likely diagnoses.