What is the diagnosis and treatment for a patient with leukocytosis (elevated White Blood Cell count), normal Comprehensive Metabolic Panel (CMP), and urinalysis showing pyuria (White Blood Cells in urine), hematuria (Red Blood Cells in urine), bacteriuria (bacteria in urine), and proteinuria (protein in urine), who is allergic to penicillin?

Differential Diagnosis

• Single most likely diagnosis
  • Urinary Tract Infection (UTI): The presence of many bacteria, WBCs (21-50), and RBCs (21-30) in the urine, along with a high pH (8.5) and significant proteinuria (100), strongly suggests a UTI. The elevated WBC count in the blood (14.8) with a high absolute neutrophil count (10.7) also supports an infectious process.
• Other Likely diagnoses
  • Pyelonephritis: Given the significant bacteriuria and the presence of RBCs and WBCs in the urine, pyelonephritis (an infection of the kidney) is a possible diagnosis, especially if the patient has symptoms like flank pain or fever.
  • Kidney Stone: The presence of RBCs in the urine could also suggest a kidney stone, especially if the patient has pain. However, the significant bacteriuria points more towards an infection.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Sepsis: Although the patient's CBC shows an elevated WBC count, which could indicate an infection, the possibility of sepsis, especially if the UTI is not promptly and adequately treated, should not be overlooked. Sepsis can be life-threatening and requires immediate attention.
  • Emphysematous Pyelonephritis: This is a severe infection of the kidney that can be life-threatening, especially in diabetic patients or those with compromised immune systems. It is characterized by the presence of gas in the kidney tissue.
• Rare diagnoses
  • Tuberculosis of the Urinary Tract: Although less common, tuberculosis can infect the urinary tract and present with similar symptoms, including hematuria and bacteriuria. The high pH of the urine might not typically be associated with TB, but it's a diagnosis to consider in endemic areas or in patients with risk factors.
  • Interstitial Nephritis: This condition, often caused by an allergic reaction (which could be relevant given the patient's allergy to penicillin), can present with similar urinary findings, including WBCs and RBCs. However, the presence of many bacteria would be unusual for interstitial nephritis.