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Differential Diagnosis for a 12-year-old Boy with Testicular Pain, Increased Urination, and Low Back Pain

  • Single most likely diagnosis
    • Urinary Tract Infection (UTI) or Pyelonephritis: The combination of testicular pain, increased urination, and low back pain could be indicative of a UTI that has ascended to the kidneys (pyelonephritis), causing referred pain to the testicles and lower back. The symptoms of frequent urination and low back pain are particularly suggestive of a urinary tract issue.
  • Other Likely diagnoses
    • Testicular Torsion: Although less likely given the additional symptoms of increased urination and low back pain, testicular torsion is a condition that requires urgent attention. It typically presents with sudden, severe testicular pain and might be accompanied by nausea and vomiting.
    • Epididymitis: This is an inflammation of the epididymis (the tube at the back of the testicle that stores and carries sperm) and can be caused by bacterial infection. Symptoms include testicular pain, swelling, and increased urination if the infection involves the urinary tract.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Testicular Cancer with Metastasis: Although rare in children, testicular cancer can present with testicular pain and, if metastasized, could cause low back pain due to vertebral involvement. Early detection is crucial for effective treatment.
    • Spinal or Testicular Vascular Malformations: Rare conditions that could lead to testicular pain and other systemic symptoms due to malformation or obstruction of blood vessels.
  • Rare diagnoses
    • Henoch-Schönlein Purpura (HSP): A form of vasculitis that can cause testicular pain among other symptoms like purpura, joint pain, and gastrointestinal issues. It's more common in children but would be an unusual cause of the specific combination of symptoms described.
    • Sickle Cell Disease with Crisis: In patients with sickle cell disease, a crisis can cause a wide range of symptoms including pain episodes that might involve the testicles and lower back due to vaso-occlusive crises.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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