Differential Diagnosis for Hematuria in a 62-year-old Male with a History of Cocaine Abuse
Single Most Likely Diagnosis
- Benign Prostatic Hyperplasia (BPH): Given the patient's age, BPH is a common condition that can cause hematuria due to prostate enlargement leading to urethral obstruction and subsequent bladder outlet obstruction.
Other Likely Diagnoses
- Urinary Tract Infection (UTI): UTIs are common in older adults and can cause hematuria. The patient's age and potential for incomplete bladder emptying due to BPH increase the risk.
- Kidney Stones: Cocaine abuse can lead to vasoconstriction, potentially increasing the risk of kidney stone formation. Hematuria is a common symptom of kidney stones.
- Bladder Cancer: Although less common, bladder cancer is a consideration, especially in older adults. Risk factors include smoking and certain chemical exposures, but cocaine abuse is not a well-documented risk factor.
Do Not Miss Diagnoses
- Rhabdomyolysis: Cocaine abuse can lead to rhabdomyolysis, a condition where muscle tissue breaks down, releasing myoglobin into the blood, which can cause kidney damage and lead to hematuria. This condition is life-threatening and requires immediate attention.
- Aortic Aneurysm or Aortic Dissection: Although rare, these conditions can cause hematuria if there is retroperitoneal bleeding. Given the patient's age and potential for vascular disease, this is a critical diagnosis not to miss.
- Sepsis: In the context of a UTI or other infection, sepsis is a potentially life-threatening condition that requires prompt recognition and treatment.
Rare Diagnoses
- Vasculitis: Certain types of vasculitis, such as granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis), can cause hematuria. However, these conditions are rare and typically present with other systemic symptoms.
- Sickle Cell Disease or Trait: If the patient has sickle cell disease or trait, which is less common in a 62-year-old but possible, hematuria can occur due to sickling in the kidney.
- Arteriovenous Malformation (AVM) or Arteriovenous Fistula (AVF): These vascular anomalies can cause hematuria but are rare and often associated with other symptoms such as flank pain or a palpable mass.