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 fever and right CVA (costovertebral angle) pain are consistent with an upper urinary tract infection.
• Other Likely Diagnoses
  • Urinary Tract Infection (UTI): A UTI could be a possible diagnosis, especially considering the recent cystoscopy and history of kidney stones. However, the presence of CVA pain suggests an upper urinary tract involvement, making pyelonephritis more likely.
  • Nephrolithiasis (Kidney Stone): The patient's history of kidney stones and current CVA pain could indicate a new stone or an obstructing stone causing infection or inflammation.
• Do Not Miss Diagnoses
  • Sepsis: Although less likely, sepsis is a potentially life-threatening condition that could arise from an untreated or severe urinary tract infection. The presence of fever and potential urinary source infection necessitates consideration of sepsis.
  • Perinephric Abscess: This is a serious condition that could result from an untreated pyelonephritis or obstructing kidney stone. It requires prompt diagnosis and treatment to prevent severe complications.
• 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 issues like kidney stones.
  • Emphysematous Pyelonephritis: A rare, severe infection of the kidney, more common in diabetic patients, characterized by gas formation in the kidney tissue. Although rare, it's a critical diagnosis to consider due to its high mortality rate.