Differential Diagnosis for 72-year-old Female Patient
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): The patient's symptoms of dysuria, burning sensation at the end of urination, fever, and myalgia are classic for a UTI. The absence of hematuria and decreased urine output does not rule out this diagnosis, especially in an elderly patient who may present with atypical symptoms.
Other Likely Diagnoses
- Pyelonephritis: Given the patient's history of kidney stones and the presence of fever, myalgia, and dysuria, pyelonephritis is a possible diagnosis. The patient's symptoms of fatigue, nausea, and decreased appetite also support this diagnosis.
- Dehydration: Although the patient is tolerating oral liquids and solids, her decreased appetite and symptoms of fatigue and myalgia could be indicative of dehydration, especially in the context of fever and possible UTI.
- Diabetic Ketoacidosis (DKA): The patient's history of diabetes, combined with symptoms of fatigue, nausea, and decreased appetite, raises the possibility of DKA, although the absence of vomiting and specific mention of tolerating oral intake makes this less likely.
Do Not Miss Diagnoses
- Sepsis: Any infection in an elderly patient can quickly progress to sepsis, which is a life-threatening condition. The presence of fever, myalgia, and fatigue warrants consideration of sepsis, especially if the patient's condition deteriorates.
- Kidney Stone with Infection: Given the patient's history of kidney stones, a current stone causing an obstruction and leading to infection is a critical diagnosis not to miss.
- Pneumonia: Although the patient denies nasal congestion, rhinorrhea, or cough, atypical presentations of pneumonia can occur in elderly patients, presenting with fever and non-respiratory symptoms.
Rare Diagnoses
- Tuberculosis (TB) of the Urinary Tract: Although rare, TB can affect the urinary tract and present with symptoms similar to a UTI, including dysuria and frequency. The patient's chronic symptoms and possible exposure history (though not provided) could make this a consideration.
- Interstitial Nephritis: This condition, often caused by medications or infections, can present with similar symptoms to a UTI, including dysuria and fever. Given the patient's history of multiple medications for her chronic conditions, this is a rare but possible diagnosis.