Differential Diagnosis for a 34-year-old Incarcerated Male with Significant Weight Gain and Bilateral Lower Extremity Swelling

• Single Most Likely Diagnosis
  • Lymphedema: Given the patient's significant weight gain and the onset of swelling since incarceration, lymphedema is a strong consideration. The condition can be primary or secondary, with the latter often resulting from damage to or obstruction of lymph nodes, which could be related to the patient's sedentary lifestyle during incarceration or other factors such as previous surgeries or infections. The left-sided predominance of pain and swelling could indicate a more pronounced effect on the left lymphatic system.
• Other Likely Diagnoses
  • Deep Vein Thrombosis (DVT): Although the patient denies respiratory symptoms, DVT should be considered, especially given the recent significant weight gain and the potential for prolonged periods of immobility during incarceration. The pain and swelling, particularly if worse on one side, could be indicative of a DVT.
  • Cellulitis or Skin Infection: The patient's history of a skin condition and the presence of pain and swelling in the lower extremities could suggest a skin infection such as cellulitis, which might be related to or exacerbated by the patient's weight gain and potential for poor skin care during incarceration.
  • Chronic Venous Insufficiency: This condition could lead to swelling, pain, and changes in the skin of the lower extremities, especially if the patient has been less mobile during incarceration, leading to increased venous pressure.
• Do Not Miss Diagnoses
  • Nephrotic Syndrome: Although less likely, nephrotic syndrome could cause significant weight gain and lower extremity swelling due to hypoalbuminemia. It's crucial to consider this diagnosis due to its potential for serious complications if left untreated.
  • Heart Failure: Despite no reported history of heart disease, new-onset heart failure could present with weight gain and bilateral lower extremity swelling. Given the potential severity of this condition, it should not be overlooked.
  • Pulmonary Embolism: While the patient denies respiratory symptoms, pulmonary embolism can sometimes present atypically, and given the risk factors for DVT, it's essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
• Rare Diagnoses
  • Lipedema: A rare condition characterized by the abnormal growth of fat cells in the legs, leading to swelling and pain. It's more common in women but can occur in men, especially with significant weight gain.
  • Filariasis: In the context of incarceration, travel history or exposure to endemic areas might be relevant. This parasitic infection can cause lymphedema, among other symptoms.
  • Sarcoidosis: A systemic disease that can affect multiple organs, including the lymphatic system, potentially leading to lymphedema. It might also explain the patient's past evaluation by a rheumatologist if there were concerns about joint symptoms or other systemic manifestations.