Differential Diagnosis for 64-year-old Male with Fever, Right CVA Pain, and History of Kidney Stones and Recent Cystoscopy

• Single Most Likely Diagnosis
  • Pyelonephritis: Given the patient's history of kidney stones and recent cystoscopy, pyelonephritis is a likely diagnosis. The presence of fever and right costovertebral angle (CVA) pain supports this diagnosis, as these symptoms are commonly associated with upper urinary tract infections.
• Other Likely Diagnoses
  • Nephrolithiasis (Kidney Stones): The patient's history of kidney stones and current symptoms of fever and CVA pain could indicate an obstructing stone causing infection or inflammation.
  • Urinary Tract Infection (UTI): A UTI, especially one involving the upper urinary tract, could explain the fever and CVA pain, particularly in the context of a recent cystoscopy which might have introduced bacteria into the urinary system.
• Do Not Miss Diagnoses
  • Sepsis: Although less likely, sepsis is a potentially life-threatening condition that could arise from an untreated or severe infection. The presence of fever and a potential source of infection (e.g., pyelonephritis or UTI) necessitates consideration of sepsis.
  • Perinephric Abscess: This is a serious condition that could result from an untreated or severe kidney infection. It presents with symptoms similar to pyelonephritis but requires urgent drainage.
• Rare Diagnoses
  • Xanthogranulomatous Pyelonephritis: A rare form of chronic pyelonephritis that could present with similar symptoms, especially in the context of long-standing urinary tract obstruction (e.g., due to kidney stones).
  • Emphysematous Pyelonephritis: A rare, severe infection of the kidney characterized by gas formation in the renal parenchyma, typically seen in diabetic patients but could be considered in any patient with severe urinary tract infection and systemic symptoms.