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) could indicate a severe infection leading to sepsis, which would explain the systemic inflammatory response.
- Other Likely Diagnoses
- Epididymitis: Scrotal pain and inflammation are common symptoms of epididymitis, which is often caused by a bacterial infection. The presence of bacteria in the urinalysis supports this diagnosis.
- Prostatitis: The symptoms of penile discharge, scrotal pain, and inflammation could also be indicative of prostatitis, especially if the discharge is purulent.
- Pyelonephritis: Although less likely given the absence of specific symptoms like flank pain, pyelonephritis (a kidney infection) could explain the UTI symptoms and elevated CRP.
- Do Not Miss Diagnoses
- Sepsis: Given the abnormal electrolyte levels and elevated CRP, sepsis is a critical diagnosis not to miss. Sepsis can lead to organ failure and death if not promptly treated.
- Testicular torsion: Although the primary complaint is penile discharge, the scrotal pain and inflammation could also be indicative of testicular torsion, a surgical emergency.
- Rare Diagnoses
- Reiter's syndrome: A rare condition that combines urethritis, conjunctivitis, and arthritis, following a bacterial infection. The penile discharge could be a symptom of the urethritis component.
- Tuberculosis of the genitourinary tract: Although rare, TB can infect the genitourinary tract and cause symptoms similar to a UTI, including discharge and scrotal pain.