Differential Diagnosis for 25-year-old Female with Elevated WBC, CRP, Bilateral Flank Pain, Dysuria, and Lower Quadrant Abdominal Pain

• Single Most Likely Diagnosis
  • Pyelonephritis: This condition is characterized by an infection of the upper urinary tract, which could explain the elevated WBC and CRP levels, bilateral flank pain, and dysuria. The presence of lower quadrant abdominal pain could be referred pain from the kidneys or involvement of the lower urinary tract.
• Other Likely Diagnoses
  • Urinary Tract Infection (UTI) with cystitis: While the primary symptoms suggest an upper urinary tract infection, a UTI limited to the bladder (cystitis) could also present with dysuria and lower abdominal pain. The elevated inflammatory markers could indicate a more severe infection.
  • Kidney Stones (Nephrolithiasis): This condition can cause severe flank pain and dysuria if a stone is obstructing the urinary tract. Inflammation and infection can occur as complications, explaining the elevated WBC and CRP.
  • Ovarian Cyst or Torsion: Although less directly related to the urinary symptoms, an ovarian cyst or torsion could cause lower quadrant abdominal pain and potentially irritate the urinary tract, leading to dysuria.
• Do Not Miss Diagnoses
  • Sepsis: Any infection that leads to elevated WBC and CRP, especially in the context of urinary symptoms, has the potential to progress to sepsis, a life-threatening condition.
  • Appendicitis: Although the pain pattern is not typical, appendicitis can sometimes present with atypical pain locations, including flank pain, and is a surgical emergency.
  • Ectopic Pregnancy: In a female of childbearing age, ectopic pregnancy must be considered, especially with abdominal pain and potential for referred pain. It's a life-threatening condition requiring immediate intervention.
• Rare Diagnoses
  • Tuberculosis of the Urinary Tract: This chronic infection can cause a wide range of urinary symptoms, including flank pain and dysuria, and might lead to elevated inflammatory markers.
  • Interstitial Cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain, which could be considered if other diagnoses are ruled out, though it's less likely to cause elevated WBC and CRP.
  • Endometriosis: While endometriosis can cause pelvic pain, its direct connection to the urinary symptoms and elevated inflammatory markers is less clear, making it a less likely but possible diagnosis in the differential.