What is the diagnosis for an 18-year-old, nulliparous woman presenting with lower abdominal pain, nausea, vomiting, fever (hyperthermia), tachycardia, hypotension, and purulent cervical discharge, with laboratory results showing leukocytosis and pending cervical nucleic acid amplification testing, and a negative urine pregnancy test?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: April 14, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Differential Diagnosis

  • Single most likely diagnosis
    • Pelvic Inflammatory Disease (PID): The patient's symptoms of lower abdominal pain, nausea, vomiting, fever, and purulent discharge from the cervical os, along with the physical examination findings of a tender uterus and adnexa, are highly suggestive of PID. The patient's history of being sexually active and having multiple partners also increases the risk of PID.
  • Other Likely diagnoses
    • Appendicitis: Although the patient's symptoms and physical examination findings are more suggestive of PID, appendicitis is still a possible diagnosis, especially given the diffuse tenderness over the lower quadrants of the abdomen.
    • Ovarian torsion: The patient's severe abdominal pain and tenderness, along with the adnexal tenderness, could be indicative of ovarian torsion, although the lack of a palpable mass makes this less likely.
    • Ectopic pregnancy: Although the urine pregnancy test is negative, it is still possible for the patient to have an early ectopic pregnancy, especially if the test was done too early.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Ruptured ovarian cyst: A ruptured ovarian cyst can cause severe abdominal pain and tenderness, and can be life-threatening if not promptly treated.
    • Septic abortion: Although the patient's last menstrual period was 15 days ago and the urine pregnancy test is negative, it is still possible for the patient to have had a septic abortion, especially if she had a miscarriage or an incomplete abortion.
    • Perforated viscus: A perforated viscus, such as a perforated appendix or intestine, can cause severe abdominal pain and tenderness, and can be life-threatening if not promptly treated.
  • Rare diagnoses
    • Endometriosis: Although endometriosis can cause abdominal pain and tenderness, it is less likely to cause the severe symptoms and physical examination findings seen in this patient.
    • Tubo-ovarian abscess: A tubo-ovarian abscess is a possible complication of PID, but it is less likely to be the primary diagnosis in this patient, given the lack of a palpable mass.

Related Questions

What is the diagnosis for a 23-year-old woman presenting with fever, dysuria, pruritic vulvar rash, and tender ulcerated lesions on the labium minus, with laboratory results showing leukocyte esterase positive, nitrites negative, and white blood cells 15/hpf on urinalysis?
What are the implications of a 2-centimeter (cm) fibroadenoma causing breast swelling?
What is the diagnosis for a 17-year-old female presenting with intermittent, copious, white, mucoid, odorless vaginal discharge, particularly after menses, with a microscopic examination showing a predominance of squamous cells and rare polymorphonuclear leukocytes (white blood cells)?
Why are Urinary Tract Infections (UTIs) common in pregnant women?
What is the likely diagnosis for a 40-year-old woman with abdominal pain, fever, hyperleukocytosis, tachycardia, and a tender right adnexal mass?
What is the cause of infertility in a 27-year-old nulligravid woman with regular menstrual cycles and a history of pelvic inflammatory disease?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question