Case 3

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Medical Setting: A 26 year-old woman, otherwise healthy, and recently returned from her honeymoon in Mexico is seen in an internal medicine clinic.
Chief Complaint/History:
Burning with urination
Fever for 24 hours
right- sided flank pain
Physical Exam:
Young woman, appearing uncomfortable
Temperature: 40
BP: 120/70 mm Hg
Pulse: 95
Abdomen-normal
Back & right-sided flank tenderness
Pelvic-no cervical motion tenderness
Laboratory information:
Urinalysis-esterase + (a quick test for the presence of white blood cells in urine)
WBC: 18.4K/ml
Creatinine-1.3 mg/dL; urine & blood cultures sent
   appendicitis      Enterobacteriaceae      Enterococcus faecalis      pelvic inflammatory disease      pyelonephritis   
The differential diagnosis would be (1) (2) (PID), (3) . Assuming that infectious disease, the likely pathogens are (1) (E . coli) (2) .