Differential Diagnosis

The patient presents with multiple complaints, including left leg swelling, right knee pain, right upper abdominal pain, and vaginal discharge. The following differential diagnoses are organized into categories:

• Single Most Likely Diagnosis
  • Chronic venous insufficiency (left leg swelling) with associated conditions: The patient's left leg swelling worsens with standing and improves with rest, suggesting a chronic venous insufficiency. The right knee pain is managed with Zostrix cream, indicating a possible musculoskeletal issue. The right upper abdominal pain could be related to previous cholecystectomy or constipation. The vaginal discharge is non-itchy and white, which might suggest a yeast infection or bacterial vaginosis, but further testing is needed.
• Other Likely Diagnoses
  • Musculoskeletal issues (right knee pain): Osteoarthritis, tendonitis, or bursitis could be contributing to the right knee pain, which is partially managed with Zostrix cream.
  • Gastrointestinal issues (right upper abdominal pain): Constipation, irritable bowel syndrome (IBS), or inflammatory bowel disease (IBD) could be causing the abdominal pain, especially given the worsening with constipation.
  • Infectious or inflammatory conditions (vaginal discharge): Bacterial vaginosis, yeast infection, or trichomoniasis could be the cause of the vaginal discharge, although further testing is required for an accurate diagnosis.
• Do Not Miss Diagnoses
  • Deep vein thrombosis (DVT): Although the recent leg ultrasound and D-dimer are normal, it's essential to consider DVT, especially with unilateral leg swelling. However, the chronic nature and improvement with rest make this less likely.
  • Ovarian cancer or other gynecological malignancies: The presence of vaginal discharge and abdominal pain warrants consideration of gynecological cancers, although the patient's symptoms are non-specific.
  • Liver or pancreatic cancer: Given the patient's history of cholecystectomy and right upper abdominal pain, it's crucial to rule out liver or pancreatic cancer, although liver function tests are normal.
• Rare Diagnoses
  • Lymphedema: A rare condition characterized by chronic swelling, usually in one limb, which could be a consideration if other causes are ruled out.
  • Tropical diseases: Given the patient's history of living in Australia, it's essential to consider rare tropical diseases, such as filariasis, which could cause leg swelling, although this is unlikely.
  • Systemic lupus erythematosus (SLE) or other autoimmune disorders: Although the patient's inflammatory markers are elevated, the rheumatoid inflammatory markers are normal, making SLE or other autoimmune disorders less likely. However, these conditions can present with non-specific symptoms and should be considered if other diagnoses are ruled out.