Differential Diagnosis
- Single Most Likely Diagnosis
- Sepsis: The patient has a positive urinalysis with nitrite, leukocyte esterase, and many bacteria, indicating a urinary tract infection (UTI). The patient's vital signs are stable, but the presence of a UTI, along with the patient's age and comorbidities (e.g., chronic microvascular ischemic changes, lacunar infarct), makes sepsis a likely diagnosis.
- Other Likely Diagnoses
- Acute Coronary Syndrome (ACS): The EKG shows probable anterolateral infarct, age indeterminate, and abnormal T waves in lateral leads, suggesting possible ischemia. The patient's CBC shows anemia (Hb 10.6), which may be contributing to cardiac ischemia.
- Urinary Tract Infection (UTI): As mentioned earlier, the patient's urinalysis is positive for nitrite, leukocyte esterase, and many bacteria, indicating a UTI.
- Anemia: The patient's CBC shows a low hemoglobin level (10.6), which may be contributing to the patient's symptoms and EKG changes.
- Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although the patient's influenza A, B, RSV, and COVID tests are negative, a PE could still be present, especially given the patient's anemia and possible cardiac ischemia.
- Cardiac Tamponade: The patient's EKG shows pacemaker spikes or artifacts, which could be indicative of a cardiac tamponade, especially if the patient has a history of cardiac surgery or trauma.
- Intracranial Hemorrhage: Although the CT head shows no acute intracranial abnormality, it is essential to consider the possibility of an intracranial hemorrhage, especially given the patient's history of chronic microvascular ischemic changes and lacunar infarct.
- Rare Diagnoses
- Endocarditis: The patient's UTI and possible sepsis could be related to endocarditis, especially if the patient has a history of valvular heart disease or intravenous drug use.
- Aortic Dissection: The patient's EKG shows probable anterolateral infarct, which could be indicative of an aortic dissection, especially if the patient has a history of hypertension or aortic disease.