Differential Diagnosis
- Single most likely diagnosis
- Pyelonephritis: The presence of moderate blood, protein, and RBCs in the urine, along with moderate bacteria, suggests a urinary tract infection. The elevated CRP indicates significant inflammation, which is consistent with pyelonephritis. The absence of hydronephrosis and ureteral stones makes a obstructive cause less likely, but the infection can still cause significant morbidity.
- Other Likely diagnoses
- Urinary Tract Infection (UTI) with cystitis: The UA results show evidence of infection and inflammation in the urinary tract, which could be limited to the bladder (cystitis) rather than involving the kidneys (pyelonephritis).
- Diverticulitis: Although the CT scan reports diverticulosis without diverticulitis, the presence of inflammation (elevated CRP) and possible ileus could suggest early or mild diverticulitis not yet evident on imaging.
- Gastroenteritis: The fluid in portions of the small bowel and colon could indicate a gastrointestinal infection, which might also explain the mild ileus and elevated inflammatory markers.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: The elevated CRP, bands on the CBC, and evidence of infection in the UA suggest the possibility of sepsis, especially if the infection is not adequately controlled. Sepsis can lead to severe consequences, including organ failure and death, if not promptly recognized and treated.
- Perforated viscus: Although the CT scan does not show evidence of free air or perforation, a perforated viscus (such as a perforated diverticulum or ulcer) could present with similar symptoms and would require urgent surgical intervention.
- Rare diagnoses
- Vasculitis: The combination of renal involvement (suggested by the UA findings) and gastrointestinal symptoms could, in rare cases, suggest a systemic vasculitis, although this would be less common and typically accompanied by other systemic symptoms.
- Inflammatory bowel disease (IBD) flare: The presence of fluid in the bowel and elevated inflammatory markers could suggest an IBD flare, although the acute onset and specific UA findings might make this less likely without a known history of IBD.