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Differential Diagnosis for 72-year-old Female with Lower Back Discomfort, Urinary Pressure, and Fever

  • Single Most Likely Diagnosis
    • Pyelonephritis: Despite the negative urinalysis, pyelonephritis (a kidney infection) is a strong consideration given the patient's symptoms of lower back discomfort, urinary pressure, and fever. The urinalysis may be negative early in the course of the disease or if the patient has been partially treated with antibiotics.
  • Other Likely Diagnoses
    • Lower Urinary Tract Infection (UTI): Although the urinalysis is negative, UTIs can sometimes present with minimal or no findings on urinalysis, especially in older adults. The patient's history of UTIs and current symptoms support this diagnosis.
    • Musculoskeletal Back Pain: The patient's age and complaint of generalized lower back discomfort could suggest musculoskeletal back pain, which is common in the elderly. However, the presence of fever and urinary pressure makes this less likely.
  • Do Not Miss Diagnoses
    • Sepsis: Any infection, including a UTI or pyelonephritis, can lead to sepsis, a life-threatening condition. The presence of fever, even if mild, warrants consideration of sepsis, especially in an elderly patient.
    • Kidney Stone with Infection: A kidney stone can cause severe back pain and, if infected, can lead to sepsis. The absence of findings on urinalysis does not rule out this diagnosis.
    • Spinal Epidural Abscess: This is a rare but potentially deadly condition that can present with back pain and fever. It requires prompt diagnosis and treatment to prevent neurological damage.
  • Rare Diagnoses
    • Tuberculosis of the Urinary Tract: Although rare, tuberculosis can infect the urinary tract and present with chronic symptoms, including back pain and fever. A negative urinalysis does not rule out this diagnosis.
    • Malignancy: Certain malignancies, such as renal cell carcinoma, can present with back pain and systemic symptoms like fever. While rare, this diagnosis should be considered, especially if other diagnoses are ruled out.

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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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