Differential Diagnosis for Lower Respiratory Tract Infection with Hematuria in a 5-Year-Old Male Child
Single Most Likely Diagnosis
- Pneumonia with urinary tract infection (UTI): This is the most likely diagnosis given the symptoms of lower respiratory tract infection and hematuria. The middle lobe consolidation on the X-ray supports pneumonia, and hematuria could be due to a concurrent UTI, which is common in children.
Other Likely Diagnoses
- Pneumococcal pneumonia with associated hematuria: Certain bacterial pneumonias, such as those caused by Streptococcus pneumoniae, can be associated with hematuria due to the production of pneumolysin, which can cause renal damage.
- Mycoplasma pneumoniae infection: This atypical pneumonia can present with extrapulmonary manifestations, including hematuria, although it is less common in young children.
Do Not Miss Diagnoses
- Post-streptococcal glomerulonephritis (PSGN): Although less likely, PSGN is a serious condition that can follow a streptococcal infection and presents with hematuria. It's crucial to consider this diagnosis to initiate appropriate treatment and prevent long-term renal damage.
- Pulmonary embolism with renal infarction: Although rare in children, pulmonary embolism can cause hematuria if there is associated renal infarction. This diagnosis is critical to consider due to its high mortality rate if untreated.
Rare Diagnoses
- Goodpasture syndrome: A rare autoimmune disease characterized by the presence of autoantibodies against the glomerular and alveolar basement membranes, leading to both renal and pulmonary manifestations, including hematuria and pulmonary hemorrhage.
- Wegener's granulomatosis (Granulomatosis with Polyangiitis, GPA): A rare autoimmune disorder that can affect multiple organs, including the lungs and kidneys, presenting with symptoms such as hematuria and pulmonary infiltrates.