Differential Diagnosis for 27 y/o with Protein and Bilirubin in Urine, Right Lower Back Pain, and Vaginal Discharge
- Single Most Likely Diagnosis
- Pyelonephritis: This condition is likely given the combination of right lower back pain (suggestive of flank pain), protein and bilirubin in the urine (indicating kidney involvement), and the potential for systemic infection which could also explain the vaginal discharge if it's related to a broader infectious process.
- Other Likely Diagnoses
- Urinary Tract Infection (UTI): While this could be a subset of pyelonephritis, a lower urinary tract infection could also present with similar symptoms, including protein and bilirubin in the urine due to inflammation and possible contamination.
- Kidney Stone: Could cause the right lower back pain and potentially lead to infection or obstruction that results in protein and bilirubin in the urine.
- Pelvic Inflammatory Disease (PID): Given the vaginal discharge, PID is a consideration, especially if the discharge is purulent. It could also indirectly relate to the urinary symptoms if there's an associated urinary tract infection.
- Do Not Miss Diagnoses
- Sepsis: If the patient's condition is due to an infection (like pyelonephritis or PID) that has progressed to sepsis, it's critical to identify and treat promptly due to the high mortality rate associated with sepsis.
- Ectopic Pregnancy: Although less likely given the symptoms, an ectopic pregnancy could cause lower back pain and vaginal discharge. It's a critical diagnosis not to miss due to its potential for severe morbidity and mortality.
- Appendicitis: While the symptoms don't perfectly align, appendicitis can sometimes present with atypical symptoms, including flank pain if the appendix is retrocecal. It's a condition that requires prompt surgical intervention.
- Rare Diagnoses
- Lupus Nephritis: Systemic lupus erythematosus (SLE) can cause kidney inflammation, leading to protein and bilirubin in the urine, along with systemic symptoms that might include back pain and potentially vaginal discharge if there's an associated infection.
- Tuberculosis: Both renal TB (causing urinary symptoms) and genital TB (causing vaginal discharge) are rare but possible, especially in endemic areas or in individuals with risk factors for TB exposure.