Differential Diagnosis
- Single most likely diagnosis
- D) Pelvic inflammatory disease (PID): The patient's symptoms of abdominal pain, pharyngeal erythema, cervical motion tenderness, and adnexal tenderness, along with a history of multiple sexual partners and inconsistent condom use, are highly suggestive of PID. The elevated leukocyte count and erythrocyte sedimentation rate also support this diagnosis.
- Other Likely diagnoses
- A) Acute appendicitis: The patient's abdominal pain and tenderness in the right lower quadrant could suggest appendicitis. However, the presence of cervical motion tenderness and adnexal tenderness makes PID more likely.
- B) Disseminated gonococcemia: This condition could explain the patient's symptoms of abdominal pain, pharyngeal erythema, and fever. However, it is less likely than PID given the patient's presentation and the fact that disseminated gonococcemia is a less common condition.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- A) Acute appendicitis: Although PID is the more likely diagnosis, appendicitis is a surgical emergency that requires prompt attention. Missing this diagnosis could lead to severe consequences, including perforation and peritonitis.
- Ectopic pregnancy: Although the pregnancy test is negative, it is essential to consider ectopic pregnancy in any female patient of childbearing age with abdominal pain. Ectopic pregnancy is a life-threatening condition that requires immediate attention.
- Rare diagnoses
- C) Inflammatory bowel disease: While inflammatory bowel disease could cause abdominal pain and elevated inflammatory markers, it is less likely given the patient's acute presentation and the presence of cervical motion tenderness and adnexal tenderness.
- E) Secondary syphilis: Secondary syphilis could cause a range of symptoms, including pharyngeal erythema and fever. However, it is less likely than PID or other diagnoses given the patient's presentation and the fact that secondary syphilis is a less common condition.