What is the diagnosis for a patient presenting with penile discharge, hyponatremia (Sodium 126), hyperkalemia (Potassium 5.7), hypochloremia (Chloride 90), metabolic acidosis (CO2 18, Anion Gap 24), elevated C-Reactive Protein (CRP 27.2), bacteriuria (urinalysis shows bacteria), proteinuria (30 mg/dl), and scrotal pain with inflammation, alongside abdominal X-ray findings of moderate stool volume in the colon and urinalysis indicating moderate bilirubinuria?

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) suggests a UTI. The abnormal electrolyte levels (sodium 126, potassium 5.7, chloride 90, CO2 18, anion gap 24) may indicate a severe infection leading to sepsis. The scrotal pain and inflammation could be related to the infection spreading to the epididymis (epididymitis) or testes (orchitis).
• Other Likely Diagnoses
  • Epididymitis: Given the scrotal pain and inflammation, epididymitis is a strong consideration, especially if the UTI has spread to the epididymis.
  • Prostatitis: Although not directly indicated by the symptoms provided, prostatitis could be a consideration given the urinary symptoms and the potential for bacterial infection to involve the prostate.
  • Gastroenteritis: The moderate stool volume in the colon and the presence of bilirubin in the urine could suggest a gastrointestinal infection, potentially affecting the urinary system indirectly.
• Do Not Miss Diagnoses
  • Sepsis: The abnormal electrolytes and elevated CRP are concerning for sepsis, a life-threatening condition that requires immediate attention.
  • Testicular Torsion: Although the primary complaint is penile discharge, the scrotal pain and inflammation necessitate considering testicular torsion, a surgical emergency.
  • Kidney Stones: The presence of bacteria and protein in the urine, along with scrotal pain, could potentially be related to a kidney stone causing an obstruction and subsequent infection.
• Rare Diagnoses
  • Reiter's Syndrome ( Reactive Arthritis): This condition, characterized by the triad of arthritis, urethritis, and conjunctivitis, could be considered if the patient has a history of recent infection and presents with urethral discharge and joint symptoms.
  • Tuberculosis of the Genitourinary Tract: Although rare, TB can affect the genitourinary system, presenting with chronic infections, discharge, and systemic symptoms like weight loss and fever. The presence of bilirubin in the urine might suggest a more systemic or chronic condition.