Differential Diagnosis for High Ferritin, Bilateral Calf Pain

Single Most Likely Diagnosis

• Idiopathic Hyperferritinemia: This condition is characterized by elevated ferritin levels without iron overload, which aligns with the normal total iron, TIBC, saturation, and transferrin levels in the patient. The bilateral calf pain could be related to various factors, including muscle strain or overuse, which are common and might not directly correlate with the high ferritin levels but are a frequent complaint in the general population.

Other Likely Diagnoses

• Hemochromatosis: Although the total iron, TIBC, saturation, and transferrin levels are normal, hemochromatosis can sometimes present with elevated ferritin levels before significant alterations in iron studies are evident. The absence of redness, swelling, and the presence of normal pulses make this less likely but still a consideration.
• Inflammatory Conditions: Conditions like rheumatoid arthritis or other autoimmune diseases can cause elevated ferritin levels due to inflammation. The bilateral calf pain could be a manifestation of an underlying inflammatory process affecting the musculoskeletal system.
• Metabolic Myopathies: Certain metabolic myopathies can cause muscle pain and elevated ferritin levels. These conditions are less common but should be considered in the differential diagnosis.

Do Not Miss Diagnoses

• Thrombophlebitis or Deep Vein Thrombosis (DVT): Although pulses are normal and there's no redness or swelling, DVT can sometimes present subtly, especially in its early stages. The risk of missing this diagnosis and the potential for severe consequences (pulmonary embolism) make it a "do not miss" condition.
• Compartment Syndrome: This is a medical emergency that can cause severe pain, often out of proportion to the physical findings. Early diagnosis is crucial to prevent long-term damage.

Rare Diagnoses

• Gaucher's Disease: A rare genetic disorder that can cause elevated ferritin levels among other systemic manifestations. It's less likely but could be considered if other diagnoses are ruled out and there are additional systemic symptoms.
• Porphyrias: Certain types of porphyria can cause muscle pain and elevated ferritin levels. These are rare conditions but should be kept in mind, especially if other symptoms such as neurological manifestations are present.