Differential Diagnosis
- Single most likely diagnosis
- Urinary Tract Infection (UTI) with possible sepsis: The presence of penile discharge, bacteria in urinalysis, and elevated CRP (27.2) strongly suggests a UTI. The abnormal electrolyte levels (sodium 126, potassium 5.7, chloride 90, CO2 18, anion gap 24) could indicate a severe infection leading to sepsis, which would explain the scrotal pain and systemic inflammation.
- Other Likely diagnoses
- Epididymitis: Given the scrotal pain and penile discharge, epididymitis (inflammation of the epididymis) is a plausible diagnosis, possibly caused by a bacterial infection.
- Prostatitis: The symptoms of penile discharge and scrotal pain, along with the urinalysis findings, could also suggest prostatitis, especially if the discharge is from the prostate.
- Urethritis: This condition, characterized by inflammation of the urethra, could explain the penile discharge and is often caused by bacterial infections.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although mentioned as part of the single most likely diagnosis, it's crucial to highlight sepsis separately due to its high mortality rate if not promptly treated. The elevated CRP, abnormal electrolytes, and presence of a UTI suggest sepsis as a critical condition not to miss.
- Testicular torsion: Although less likely given the presence of infection signs, testicular torsion is a medical emergency that can cause scrotal pain and must be ruled out to prevent testicular loss.
- Rare diagnoses
- Reiter's syndrome: A rare condition that involves urethritis, conjunctivitis, and arthritis, following a bacterial infection. It could be considered if the patient has additional symptoms like arthritis or eye inflammation.
- Tuberculosis of the genitourinary tract: Although rare, it could present with chronic symptoms including discharge and systemic symptoms like weight loss and fever, especially in endemic areas or in immunocompromised patients.