Differential Diagnosis
- Single Most Likely Diagnosis + Urinary Tract Infection (UTI) or Pyelonephritis: The presence of penile discharge, lower abdominal pain, and urinalysis showing bacteria, protein, and bilirubin in the urine strongly suggests a UTI. The elevated CRP and anion gap also indicate a significant inflammatory response, which could be consistent with pyelonephritis, an infection of the upper urinary tract.
- Other Likely Diagnoses + Prostatitis: Given the symptoms of penile discharge and lower abdominal pain, prostatitis (inflammation of the prostate) is a possible diagnosis, especially if the discharge is purulent and the patient has other symptoms like dysuria or frequency. + Gastroenteritis: The symptoms of nausea, chills, diarrhea, and moderate stool volume in the colon could suggest a gastrointestinal infection. However, the primary focus on urinary symptoms and findings might make this less likely as a primary diagnosis. + Epididymitis: This is an inflammation of the epididymis (a tube at the back of the testicle that stores and carries sperm) and could present with similar symptoms, including pain and discharge. The negative tests for gonorrhea and chlamydia reduce but do not eliminate this possibility, as other pathogens could be responsible.
- Do Not Miss Diagnoses + Sepsis: The combination of symptoms such as chills, nausea, elevated CRP, and an abnormal anion gap could indicate sepsis, a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. Early recognition and treatment are crucial. + Kidney Stones with Infection: While the primary symptoms suggest an infection, the presence of lower abdominal pain could also indicate kidney stones, especially if there's an associated infection, which would require urgent treatment.
- Rare Diagnoses + Tuberculosis (TB) of the Urinary Tract: Although less common, TB can affect the urinary tract and present with chronic symptoms including discharge, pain, and systemic symptoms like weight loss and fever. The diagnosis would be considered rare in many populations but should be kept in mind, especially in high-risk individuals. + Schistosomiasis: This parasitic infection can cause urinary symptoms, including hematuria and discharge, and is more common in certain geographic areas. It would be a rare consideration in most clinical settings without specific travel or exposure history.