Differential Diagnosis
- Single most likely diagnosis
- Kidney stone (nephrolithiasis): The patient's symptoms of flank pain, dysuria, and gross hematuria are classic for a kidney stone. The fact that the patient was relieved of symptoms after treatment with Sambong capsule (likely containing phytotherapy for urinary tract issues) and Ciprofloxacin, but then had a recurrence of symptoms, suggests a possible obstruction or irritation in the urinary tract, which is consistent with a kidney stone.
- Other Likely diagnoses
- Urinary Tract Infection (UTI): Although the patient was treated with Ciprofloxacin and had relief of symptoms, the recurrence of pain without fever or gross hematuria could still suggest a UTI, possibly due to incomplete treatment or resistance to the antibiotic.
- Pyelonephritis: This is an infection of the kidney, which could cause flank pain and other urinary symptoms. However, the absence of fever makes this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although the patient does not have a fever, sepsis can present atypically, especially in older or immunocompromised patients. If the patient's condition worsens or if they show signs of systemic illness, sepsis should be considered.
- Renal infarction or embolism: These conditions can cause severe flank pain and are medical emergencies. Although less likely, they should be considered, especially if the patient has risk factors for thromboembolic events.
- Rare diagnoses
- Renal cell carcinoma: This type of cancer can cause flank pain and hematuria, but it is less likely given the patient's age and the acute presentation of symptoms.
- Retroperitoneal fibrosis: This is a rare condition that can cause urinary obstruction and flank pain, but it is less common and would typically have a more gradual onset of symptoms.