Differential Diagnosis for Left Lower Limb Swelling and Pain
Single Most Likely Diagnosis
- Cellulitis: This is a common condition characterized by skin and subcutaneous tissue infection, often presenting with swelling, pain, and redness. The presence of pain near the toes and dorsum of the foot, along with mildly raised eosinophils (which could be seen in response to infection), makes cellulitis a plausible diagnosis. The normal CRP and uric acid levels do not rule out this condition.
Other Likely Diagnoses
- Deep Vein Thrombosis (DVT): Although DVT typically presents with more significant swelling and possibly warmth of the affected limb, it should be considered, especially if there's a history of immobility, cancer, or other thrombotic risk factors. The normal CRP does not specifically rule out DVT.
- Gout: Despite normal uric acid levels, gout can still be considered, especially if the pain is localized around the toes (podagra). Uric acid levels can be normal during an acute gout attack.
- Eczema/Dermatitis: With mildly raised eosinophils, an allergic or atopic component could be contributing to the symptoms, possibly through a condition like eczema or dermatitis, which could cause swelling and pain, especially if there's a secondary infection.
Do Not Miss Diagnoses
- Compartment Syndrome: A medical emergency that requires immediate attention. It presents with severe pain, especially on passive stretching of the muscles within the compartment, and can lead to limb loss if not promptly treated.
- Necrotizing Fasciitis: Another emergency condition that is a severe infection of the skin and subcutaneous tissue, which can rapidly progress and is life-threatening.
- Osteomyelitis: An infection of the bone that can cause pain and swelling and requires prompt antibiotic treatment to prevent long-term damage.
Rare Diagnoses
- Eosinophilic Fasciitis: A rare condition characterized by inflammation of the fascia (the tissue surrounding muscles), which can cause swelling, pain, and skin thickening. The mildly raised eosinophils could support this diagnosis, but it is much less common.
- Chronic Lymphedema: While more commonly associated with significant swelling rather than pain, chronic lymphedema could be considered if there's a history of lymph node removal or radiation therapy affecting lymphatic drainage.
- Sarcoidosis: A systemic disease that can cause inflammation in various parts of the body, including the skin, and could potentially present with limb swelling and pain, though it would be an uncommon initial presentation.