Differential Diagnosis
- Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): The presence of penile discharge, bacteria in urinalysis, and elevated CRP (27.2) strongly suggests a UTI. The patient's metabolic profile, including hyponatremia (Sodium 126), hyperkalemia (potassium 5.7), and elevated anion gap (24), could be indicative of a severe infection affecting renal function.
- Other Likely Diagnoses
- Sepsis: Given the elevated CRP and the presence of a UTI, sepsis is a possible complication, especially if the infection is not promptly treated. The metabolic abnormalities could be part of a systemic response to infection.
- Kidney Stones or Obstruction: The urinalysis findings and the presence of bilirubin in the urine could suggest an obstructive process or kidney stones, which might be causing or contributing to the UTI.
- Prostatitis: This condition, especially if acute, could present with similar symptoms, including penile discharge, and could be considered in the differential diagnosis, especially if the patient has symptoms like perineal pain or urinary retention.
- Do Not Miss Diagnoses
- Sepsis with Septic Shock: Although mentioned under other likely diagnoses, it's crucial to emphasize that missing sepsis with potential progression to septic shock could be fatal. The patient's metabolic profile and elevated CRP warrant close monitoring for signs of sepsis.
- Acute Kidney Injury (AKI): The electrolyte imbalances and the presence of an elevated anion gap could indicate AKI, which is a critical condition requiring immediate attention.
- Urosepsis with Obstruction: If there's an obstructive cause (like kidney stones) leading to urosepsis, missing this diagnosis could lead to severe consequences, including septic shock and death.
- Rare Diagnoses
- Tuberculosis of the Genitourinary Tract: Although rare, genitourinary tuberculosis could present with chronic symptoms, including discharge, and might be considered if common causes are ruled out and there's a high suspicion based on exposure history or other systemic symptoms.
- Malignancy: Certain malignancies, like prostate or bladder cancer, could present with obstructive symptoms or recurrent infections, but these would be less likely given the acute presentation described.