A 28-year-old woman presents to the clinic with burning pain during urination, increased frequency, and an urgent need to use the restroom for the past two days. She denies having any fever, chills, or back pain.
Case Findings & Vitals
• Vitals:** Temp 36.8°C (98.2°F), HR 72 bpm, BP 120/78 mmHg.
• Physical Exam: Mild tenderness just above the pubic bone (suprapubic area). No flank or back tenderness.
• Urinalysis: Positive for leukocyte esterase and nitrites; moderate white blood cells present.
Choose Correct Option:
A) Acute Pyelonephritis (kidney infection); admit to the hospital for intravenous (IV) antibiotics. B) Acute Simple Cystitis (bladder infection); prescribe a short course of oral antibiotics like nitrofurantoin. C) Nephrolithiasis (kidney stones); perform an emergency CT scan of the abdomen and pelvis. D) Pelvic Inflammatory Disease (PID); initiate intramuscular ceftriaxone and oral doxycycline.
it is a classic presentation of acute cystitis, because there is no flank pain or tenderness. So there is no upper urinary tract involvement. pain over suprapubic area is highly suggestive of this diagnosis.it is lower urinary tract infection mostly caused due to gram negative bacteria since it shows it is nitrite positive.
I will go with option B: Acute Simple Cystitis (bladder infection); prescribe a short course of oral antibiotics like nitrofurantoin.
Based on positive leukocyte esterase and nitrite, and a moderate white blood cell count, the urine test indicates a bacterial urinary tract infection. Still, it cannot determine whether the infection is in the bladder or the kidney.
Moreover, the patient denies having any fever, chills, or back pain.
Usually, a kidney infection (pyelonephritis) is associated with High fever, chills, pain in the side or back (flank pain), nausea or vomiting, and often urinary symptoms.
The combination of lower urinary tract irritative symptoms (dysuria, urgency, frequency), suprapubic tenderness, and a urinalysis positive for leukocyte esterase and nitrites is classic for uncomplicated cystitis. The absence of fever, chills, and costovertebral angle (flank) tenderness effectively rules out acute pyelonephritis, meaning she can be safely treated as an outpatient with a short course of first-line oral antibiotics like Nitrofurantoin.