Differential Diagnosis
- Single most likely diagnosis
- Urinary Tract Infection (UTI): The patient's symptoms of progressive dysuria, frequency, and sometimes chills and body aches, along with the positive response to iprofloxacin and phenazopyridine, suggest a UTI. The recent worsening of symptoms with certain beverages and the presence of white discharge also support this diagnosis.
- Other Likely diagnoses
- Interstitial Cystitis: The patient's symptoms of dysuria, frequency, and pelvic pain, especially with certain beverages, could be indicative of interstitial cystitis. The presence of suprapubic tenderness and the minimal response to antifungals and antibiotics also support this diagnosis.
- Irritable Bowel Syndrome (IBS): The patient's symptoms of bloating, abdominal pain, and changes in bowel habits, especially after eating, could be indicative of IBS. The presence of a fatty liver and hepatic cyst on ultrasound also suggests a possible gastrointestinal component.
- Endometriosis: The patient's symptoms of pelvic pain, dysuria, and spotting could be indicative of endometriosis. The presence of a small fibroid on ultrasound and the patient's age also support this diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pyelonephritis: The patient's symptoms of flank pain, dysuria, and sometimes chills and body aches could be indicative of pyelonephritis. The presence of left CVA tenderness and the patient's recent urinary symptoms make this a diagnosis that should not be missed.
- Ovarian Torsion: The patient's symptoms of pelvic pain and the presence of a small fibroid on ultrasound could be indicative of ovarian torsion. The fact that the right ovary was not visualized on ultrasound due to bowel gas makes this a diagnosis that should be considered.
- Appendicitis: The patient's symptoms of abdominal pain, especially in the suprapubic region, and the presence of a limited view of the pancreas on ultrasound due to bowel gas could be indicative of appendicitis. The patient's age and symptoms make this a diagnosis that should not be missed.
- Rare diagnoses
- Tuberculosis: The patient's symptoms of dysuria, frequency, and sometimes chills and body aches, along with the presence of a fatty liver and hepatic cyst on ultrasound, could be indicative of tuberculosis. The patient's recent travel history and exposure to certain populations could support this diagnosis.
- Malacoplakia: The patient's symptoms of dysuria, frequency, and sometimes chills and body aches, along with the presence of a white discharge, could be indicative of malacoplakia. The patient's age and symptoms make this a rare but possible diagnosis.