Differential Diagnosis for a 35-year-old woman at 35 weeks gestation with fever and chills
- Single most likely diagnosis:
- Persistent or recurrent pyelonephritis: The patient was recently admitted for acute pyelonephritis and started on broad-spectrum intravenous antibiotics but continues to have a fever, suggesting that the infection may not be fully resolved or has recurred. The tenderness over the right flank further supports this diagnosis.
- Other Likely diagnoses:
- Intrapartum infection (Chorioamnionitis): Although the patient has not had painful contractions, leakage of fluid, or vaginal bleeding, the presence of fever and chills in a pregnant woman at term could indicate an intrapartum infection. However, the intact amniotic membranes and lack of other symptoms make this less likely.
- Septic thrombophlebitis: This condition, which involves infection of a vein, could explain the persistent fever despite antibiotic treatment. It is a consideration in patients with prolonged intravenous access, such as this patient.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Placental abruption: Although the patient does not have vaginal bleeding, which is a common symptom of placental abruption, this condition can sometimes present with minimal or no bleeding. The presence of fever and chills, combined with the risk of infection, makes it crucial to consider this diagnosis.
- Pulmonary embolism: Given the patient's pregnancy status and recent hospitalization, she is at increased risk for pulmonary embolism. While the presentation does not strongly suggest this diagnosis, it is critical to consider due to its high mortality rate if missed.
- Rare diagnoses:
- Listeriosis: Although rare, listeriosis can cause fever and chills in pregnant women. Given the patient's recent admission for pyelonephritis and the fact that she is immunocompromised due to pregnancy, this diagnosis should be considered, especially if other causes are ruled out.
- Endocarditis: If the patient has a history of heart disease or intravenous drug use, endocarditis could be a rare but possible cause of her symptoms. However, without additional risk factors or symptoms such as a new heart murmur, this diagnosis is less likely.