Differential Diagnosis for a 24-year-old Woman with Dysuria and Hematuria
- Single most likely diagnosis:
- Endometriosis: The patient's symptoms of dysuria and hematuria recurring a few days prior to menses, and resolving spontaneously, are suggestive of endometriosis affecting the bladder. The presence of bladder tenderness on palpation of the anterior vaginal wall and the absence of infection on urinalysis and urine culture support this diagnosis.
- Other Likely diagnoses:
- Interstitial Cystitis: This condition is characterized by bladder pain, dysuria, and hematuria, often without evidence of infection. The patient's symptoms of burning with urination and blood-tinged urine, along with bladder tenderness, could be consistent with interstitial cystitis.
- Urethral Syndrome: This condition presents with symptoms of dysuria, frequency, and urgency, often without evidence of infection. The patient's symptoms of burning with urination and the absence of infection on urinalysis and urine culture could suggest urethral syndrome.
- Do Not Miss diagnoses:
- Bladder Cancer: Although rare in young women, bladder cancer can present with hematuria and dysuria. The presence of moderate blood on urinalysis and many red blood cells per high power field warrants further investigation to rule out this potentially life-threatening condition.
- Kidney Stones: While the patient does not have flank pain or costovertebral angle tenderness, kidney stones can sometimes present with dysuria and hematuria. It is essential to consider this diagnosis, especially if the patient's symptoms worsen or if further evaluation is indicated.
- Rare diagnoses:
- Schistosomiasis: This parasitic infection can cause bladder symptoms, including dysuria and hematuria, particularly in individuals who have traveled to or lived in endemic areas. Although rare, it should be considered in patients with unexplained bladder symptoms and a relevant travel history.
- Tuberculosis of the Urinary Tract: This condition can present with dysuria, hematuria, and frequency. While rare, it is essential to consider this diagnosis in patients with unexplained urinary symptoms, especially if they have a history of exposure to tuberculosis or have traveled to endemic areas.