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PMCPatients_common477 | [
{
"from": "human",
"value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 63-year-old female with a history of nephrolithiasis and recently diagnosed diabetes mellitus presented with acute onset of fever and abdominal pain following a coughing episode. Exam was notable for a palpable right-sided abdominal mass and drainage from the umbilicus. Subsequently, the right flank wound was surgically debrided, and a nephrostomy catheter was placed. The hematoma fluid aspirate cultures grew Escherichia coli and Streptococcus anginosus, intraoperative tissue cultures grew E. coli, and blood cultures remained negative. Antimicrobial therapy was initially narrowed to cefepime monotherapy but was later switched to ampicillin-sulbactam due to development of thrombocytopenia, and then to ceftriaxone for definitive inpatient treatment. The drain was exchanged, and a percutaneous nephrostomy was placed three days later. Urology considered a high surgical risk patient for nephrectomy at that moment and suggested that having the drains in place could be the best source control. The patient was discharged home with levofloxacin and metronidazole after 41 days of inpatient antimicrobial therapy. Antimicrobials were discontinued after completing 91 days of therapy, with the drains remaining in place and producing clear fluid. The patient remained afebrile and asymptomatic during the following 180 days with plans for definitive treatment with nephrectomy.\nOUTPUT:"
},
{
"from": "agent",
"value": "Right retroperitoneal hematoma, Xanthogranulomatous pyelonephritis, Rectus abdominis diastasis with a large bowel-containing hernia, Perinephric abscess"
}
] | As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.
INPUT: A 63-year-old female with a history of nephrolithiasis and recently diagnosed diabetes mellitus presented with acute onset of fever and abdominal pain following a coughing episode. Exam was notable for a palpable right-sided abdominal mass and drainage from the umbilicus. Subsequently, the right flank wound was surgically debrided, and a nephrostomy catheter was placed. The hematoma fluid aspirate cultures grew Escherichia coli and Streptococcus anginosus, intraoperative tissue cultures grew E. coli, and blood cultures remained negative. Antimicrobial therapy was initially narrowed to cefepime monotherapy but was later switched to ampicillin-sulbactam due to development of thrombocytopenia, and then to ceftriaxone for definitive inpatient treatment. The drain was exchanged, and a percutaneous nephrostomy was placed three days later. Urology considered a high surgical risk patient for nephrectomy at that moment and suggested that having the drains in place could be the best source control. The patient was discharged home with levofloxacin and metronidazole after 41 days of inpatient antimicrobial therapy. Antimicrobials were discontinued after completing 91 days of therapy, with the drains remaining in place and producing clear fluid. The patient remained afebrile and asymptomatic during the following 180 days with plans for definitive treatment with nephrectomy.
OUTPUT: |