Differential Diagnosis for Male Patient with Urinary Symptoms

The patient presents with burning urination, back pain, blood in urine, malaise, and fatigue without fever. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Urinary Tract Infection (UTI) or Pyelonephritis: Although the urinalysis is mostly normal except for blood, the symptoms of burning urination and back pain are classic for a UTI, especially if the infection has ascended to the kidneys (pyelonephritis), which could explain the back pain. The absence of fever does not rule out this diagnosis, especially in early stages or in patients with compromised immune systems.

• Other Likely Diagnoses

  • Kidney Stones (Nephrolithiasis): The presence of blood in the urine (hematuria) and back pain are key indicators of kidney stones. The burning sensation during urination could be due to the stone causing irritation as it moves through the urinary tract.
  • Prostatitis: Inflammation of the prostate gland can cause burning urination, back pain, and malaise. The absence of fever and a normal urinalysis except for blood does not rule out this condition, especially if it's chronic prostatitis.
  • Interstitial Cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can include burning urination, which fits the patient's presentation.

• Do Not Miss Diagnoses

  • Testicular Torsion: Although less likely given the primary symptoms, testicular torsion can sometimes present with abdominal or back pain and should always be considered in cases of acute scrotal or testicular pain, even if the primary complaint seems to be urinary.
  • Renal Cell Carcinoma or Bladder Cancer: These conditions can present with hematuria and back pain. While less common, missing these diagnoses could be catastrophic.
  • Spinal Epidural Abscess: A rare but serious condition that can present with back pain and systemic symptoms like malaise and fatigue. The absence of fever does not rule out this condition.

• Rare Diagnoses

  • Schistosomiasis: A parasitic infection that can cause hematuria and is seen in travelers to or immigrants from endemic areas. It's a rare cause of urinary symptoms in non-endemic areas.
  • Tuberculosis of the Urinary Tract: Can cause chronic symptoms including hematuria, frequency, and back pain. It's more common in immunocompromised patients or those from endemic areas.
  • Sickle Cell Disease or Sickle Cell Trait: Can cause hematuria due to sickling in the kidney. Back pain could be related to sickle cell crises.

Each of these diagnoses should be considered in the context of the patient's full medical history, travel history, sexual history, and social history, along with further diagnostic testing as indicated.