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Differential Diagnosis for Crawling Sensations on Feet

Single Most Likely Diagnosis

  • Vitamin B12 Deficiency: Although B12 levels were not measured, a deficiency in vitamin B12 can cause neurological symptoms such as crawling sensations on the skin, especially on the feet. The fact that other biomarkers are normal and the symptoms started during a viral infection (which can sometimes precipitate or exacerbate underlying deficiencies) makes this a plausible diagnosis.

Other Likely Diagnoses

  • Peripheral Neuropathy: This condition can result from various causes, including viral infections. The crawling sensations could be a manifestation of nerve damage or dysfunction, which might not be directly reflected in the provided blood work.
  • Anxiety or Stress-Related Symptoms: Sometimes, viral infections can trigger or exacerbate anxiety or stress, which can manifest as crawling sensations on the skin due to heightened sensory awareness or somatic symptom disorder.
  • Iron Deficiency or Dysregulation: Although the iron level is within a relatively normal range, the percentage saturation is on the lower side. Some individuals may experience neurological symptoms at levels of iron that are considered within the normal range but are personally low for them.

Do Not Miss Diagnoses

  • Multiple Sclerosis (MS) or Other Demyelinating Diseases: Although less likely, MS or other demyelinating diseases can present with a wide range of neurological symptoms, including unusual sensations. The fact that the symptoms started during a viral infection (which can sometimes trigger MS relapses) and the absence of other clear explanations make it crucial not to miss this diagnosis.
  • Lyme Disease or Other Tick-Borne Illnesses: If the viral infection was actually a tick-borne illness, neurological symptoms could be a part of the disease manifestation. The normal CRP and lack of other specific markers do not rule out this possibility entirely.
  • Thyroid Dysfunction: Despite the normal TSH, T4, and T3 levels, some individuals may experience symptoms due to thyroid hormone resistance or other thyroid-related issues not captured by standard thyroid function tests.

Rare Diagnoses

  • Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet. It could be considered if other diagnoses are ruled out and the symptoms persist or worsen.
  • Complex Regional Pain Syndrome (CRPS): A condition characterized by intense burning or aching pain in the hands or feet after an injury or infection. The crawling sensations could be an atypical presentation.
  • Neoplastic or Paraneoplastic Syndromes: Very rarely, neurological symptoms can be the first presentation of an underlying cancer. Although extremely unlikely given the normal blood work, it's essential to keep this in mind, especially if symptoms progress or other systemic signs develop.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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