Differential Diagnosis for 64yo Female with Dysuria

Single Most Likely Diagnosis

• Urinary Tract Infection (UTI): The presence of dysuria, positive nitrite, large leukocyte count, and turbid urine with a green appearance are all consistent with a UTI, particularly one caused by a gram-negative organism such as E. coli, which can produce nitrite and cause the urine to appear green due to the production of pyocyanin.

Other Likely Diagnoses

• Kidney Stone: While the primary symptoms suggest a UTI, the presence of small blood in the urine (hematuria) could also indicate a kidney stone, especially if the stone is causing irritation or obstruction in the urinary tract.
• Interstitial Cystitis: This condition, also known as painful bladder syndrome, could cause dysuria and hematuria, although it typically does not result in a positive nitrite test or such a significant leukocyte count.
• Prostatitis (less likely in females but can be considered in the context of pelvic pain): Though more common in men, a form of prostatitis or pelvic inflammatory disease could potentially cause similar symptoms in women, including dysuria and pelvic pain.

Do Not Miss Diagnoses

• Bladder Cancer: Hematuria, even if small, especially in an older adult, warrants consideration of bladder cancer. Although less likely than a UTI, missing this diagnosis could have severe consequences.
• Pyelonephritis: An infection of the kidney, which could present with similar urinary findings and requires prompt treatment to prevent complications such as sepsis or kidney damage.
• Sepsis (if symptoms worsen or include systemic signs): While not directly a urinary diagnosis, sepsis can result from an untreated or severe UTI, especially in older adults, and is critical not to miss due to its high mortality rate.

Rare Diagnoses

• Tuberculosis of the Urinary Tract: This could cause chronic symptoms including hematuria and dysuria, but it is much less common and typically associated with other systemic symptoms or a known history of TB.
• Schistosomiasis: A parasitic infection that can cause hematuria, but it is rare in most parts of the world and typically associated with travel to or residence in endemic areas.
• Malacoplakia: A rare inflammatory condition that can affect the urinary tract and cause hematuria and dysuria, but it is uncommon and usually associated with a history of recurrent infections.