Differential Diagnosis

• Single most likely diagnosis
  • Pelvic Inflammatory Disease (PID) with subsequent Asherman's syndrome: This is a likely diagnosis given the history of typhoid fever 3 months prior, which can increase the risk of PID due to potential bacterial translocation or immunosuppression. The symptoms of white discharge and amenorrhea for 2 months support this diagnosis, as PID can cause scarring and adhesions in the uterus, leading to amenorrhea.
• Other Likely diagnoses
  • Endometritis: This is another possible diagnosis, given the history of typhoid fever and the symptoms of white discharge and amenorrhea. Endometritis can cause scarring and adhesions in the uterus, leading to amenorrhea.
  • Tuberculosis: Although less common, tuberculosis can cause PID, endometritis, and subsequent amenorrhea. The history of typhoid fever may increase the risk of reactivation of latent tuberculosis.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Ectopic pregnancy: Although the patient is amenorrheic, an ectopic pregnancy can still occur, especially if there is a history of PID or endometritis. This diagnosis is critical to rule out due to the high risk of mortality associated with ectopic pregnancy.
  • Ovarian torsion: This is another critical diagnosis to consider, as it can cause severe abdominal pain and amenorrhea. Ovarian torsion requires prompt surgical intervention to prevent ovarian necrosis.
• Rare diagnoses
  • Schistosomiasis: This parasitic infection can cause genital lesions and subsequent amenorrhea. Although rare, it is essential to consider this diagnosis, especially if the patient has a history of travel to endemic areas.
  • Lymphogranuloma venereum (LGV): This sexually transmitted infection can cause PID, endometritis, and subsequent amenorrhea. Although rare, LGV is essential to consider, especially if the patient has a history of high-risk sexual behavior.