Differential Diagnosis for Persistent Hematuria and Cystitis in a 30-year-old Healthy Female
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): This is the most common cause of cystitis and can also lead to hematuria. The symptoms of UTI, such as dysuria, frequency, and urgency, along with the presence of blood in the urine, make it a likely diagnosis.
Other Likely Diagnoses
- Interstitial Cystitis: A condition characterized by chronic inflammation of the bladder, leading to symptoms like pelvic pain, frequency, and urgency. Hematuria can occur, especially if there is associated bladder ulceration.
- Kidney Stones: Although more common in men, women can also develop kidney stones, which can cause persistent hematuria and symptoms of cystitis if the stone is in the lower urinary tract.
- Endometriosis: In rare cases, endometriosis can involve the bladder, leading to cyclic hematuria and symptoms of cystitis.
Do Not Miss Diagnoses
- Bladder Cancer: Although rare in young women, bladder cancer can present with painless hematuria and irritative bladder symptoms. It is crucial to rule out this diagnosis due to its significant implications.
- Tuberculosis: Genitourinary tuberculosis can cause chronic cystitis and hematuria. It is essential to consider this diagnosis, especially in areas where TB is prevalent.
- Sickle Cell Disease or Trait: Sickle cell disease can cause hematuria due to sickling in the kidney. Although less common, it's a critical diagnosis not to miss due to its systemic implications.
Rare Diagnoses
- Schistosomiasis: A parasitic infection that can cause bladder inflammation and hematuria. It is rare in developed countries but should be considered in travelers to or immigrants from endemic areas.
- Bladder Malformations or Diverticula: Congenital anomalies of the bladder can lead to urinary stasis, infection, and potentially hematuria.
- Systemic Lupus Erythematosus (SLE): SLE can cause renal involvement, including hematuria and cystitis. However, it would typically be accompanied by other systemic symptoms.