Differential Diagnosis for 18 Week Pregnant Woman with Intermittent Fever and Leukocytes on UA
- Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): The presence of 2+ leukocytes on urinalysis (UA) in a pregnant woman with intermittent fever suggests a UTI, which is common during pregnancy due to physiological changes that predispose to infection.
- Other Likely Diagnoses
- Pyelonephritis: Although the patient does not have costovertebral angle (CVA) tenderness, pyelonephritis cannot be ruled out entirely, especially if the UTI has ascended to the kidneys. Pregnancy increases the risk of pyelonephritis due to ureteral dilation and decreased peristalsis.
- Viral Illness: Viral infections can cause fever and leukocytosis. In a pregnant woman, it's essential to consider viral etiologies, though they might not directly explain the leukocytes on UA.
- Do Not Miss Diagnoses
- Sepsis: Although less likely, sepsis is a life-threatening condition that can arise from any infection, including UTIs or pyelonephritis. Early recognition is crucial, especially in pregnant women, where the physiological changes of pregnancy can mask early signs of sepsis.
- Preterm Labor: Fever can be a sign of preterm labor, especially if it's associated with uterine contractions. This diagnosis is critical to consider due to the potential for significant morbidity and mortality for both the mother and the fetus.
- Rare Diagnoses
- Listeriosis: This bacterial infection is rare but can cause fever and is particularly concerning in pregnancy due to the risk of transmission to the fetus, potentially leading to severe consequences.
- Tuberculosis: Although less common, tuberculosis (TB) can present with fever and systemic symptoms. In a pregnant woman, especially one with risk factors for TB, this diagnosis should be considered to prevent maternal and fetal complications.