Differential Diagnosis for a 34-year-old Female with Fever, Jaundice, Burning Micturition, and Discharge

• Single most likely diagnosis:
  • Urinary Tract Infection (UTI): Despite the absence of significant pus cells in the urine routine microscopy (R/M), a UTI is still a strong consideration given the symptoms of burning micturition and discharge. Some UTIs, especially those caused by certain bacteria, may not always present with a high number of pus cells.
• Other Likely diagnoses:
  • Chlamydia or Gonorrhea Infection: These sexually transmitted infections (STIs) can cause symptoms of discharge and burning micturition. The presence of jaundice could be indicative of a systemic infection or a separate liver issue but is less commonly associated directly with these STIs.
  • Hepatitis: The combination of fever and jaundice suggests hepatitis, which could be viral (A, B, C, D, or E), autoimmune, or drug-induced. However, hepatitis typically does not cause burning micturition or discharge directly.
  • Pyelonephritis: An infection of the kidney, which could explain the fever and possibly the jaundice if the infection is severe enough to affect liver function. Burning micturition could be a symptom if the infection involves the lower urinary tract as well.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Sepsis: Although less likely given the specific symptoms, sepsis is a life-threatening condition that can arise from any infection, including UTIs or STIs, especially if not promptly treated. The presence of fever and jaundice could indicate a severe systemic infection.
  • Weil's Disease (Leptospirosis): A zoonotic infection that can cause jaundice, fever, and in some cases, renal and hepatic failure. It's less common but can be deadly if not diagnosed and treated promptly.
• Rare diagnoses:
  • Schistosomiasis (Bilharzia): A parasitic infection that can cause urinary symptoms, including discharge and burning micturition, along with systemic symptoms like fever. Jaundice can occur in advanced cases due to liver involvement.
  • Caroli's Disease: A rare congenital disorder of the bile ducts that can cause recurrent cholangitis, leading to jaundice and potentially systemic symptoms like fever. It's less likely to cause burning micturition directly but could be considered in a differential diagnosis for jaundice and fever.