What is the diagnosis for a patient with leukocytosis (elevated White Blood Cell count), normal Comprehensive Metabolic Panel (CMP), urinary tract infection (UTI) symptoms, including pyuria (White Blood Cells in urine), hematuria (Red Blood Cells in urine), bacteriuria (bacteria in urine), and radiographic evidence of left hydroureteronephrosis, a 3mm ureterovesical junction (UVJ) stone, and cystitis?

Differential Diagnosis

• Single most likely diagnosis
  • Urinary Tract Infection (UTI) with obstructing kidney stone:
    • The presence of many bacteria, WBCs, and RBCs in the urine, along with a 3 mm stone at or near the ureterovesical junction (UVJ) and hydroureteronephrosis, strongly suggests a UTI with an obstructing stone causing urinary retention and infection.
• Other Likely diagnoses
  • Pyelonephritis:
    • The presence of WBCs and bacteria in the urine, along with hydroureteronephrosis, suggests an upper urinary tract infection.
  • Cystitis:
    • Urinary bladder wall thickening and the presence of WBCs, RBCs, and bacteria in the urine support this diagnosis.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Sepsis:
    • Although the patient's CMP is unremarkable, the presence of an elevated WBC count and evidence of a UTI with an obstructing stone increases the risk of sepsis, particularly if the infection is not promptly treated.
  • Urosepsis:
    • Similar to sepsis, urosepsis is a life-threatening condition that can occur if the UTI spreads to the bloodstream.
  • Emphysematous pyelonephritis or cystitis:
    • Although less common, these conditions can occur, especially in diabetic patients, and are life-threatening if not promptly treated.
• Rare diagnoses
  • Xanthogranulomatous pyelonephritis:
    • A rare form of chronic pyelonephritis that can cause obstructive uropathy and renal damage.
  • Malacoplusca:
    • A rare condition characterized by the presence of calcified bacteria in the urinary tract, often associated with urinary tract infections and obstruction.