Differential Diagnosis for Patient's Right Leg Pain and Other Symptoms

The patient presents with right leg pain, sharp pains around the chest area potentially caused by Rosuvastatin, and a complex medical history including hyperlipidemia, essential hypertension, uncontrolled type 2 diabetes mellitus, hyperthyroidism, lumbar pain, unspecified osteoarthritis, night sweats, menopausal symptoms, elevated D-dimer, and vitamin D deficiency.

• Single Most Likely Diagnosis:
  • Musculoskeletal pain (e.g., due to osteoarthritis or muscle strain) - This is likely given the patient's history of lumbar pain and unspecified osteoarthritis, which could contribute to or exacerbate leg pain.
• Other Likely Diagnoses:
  • Peripheral arterial disease (PAD) - Given the patient's history of hyperlipidemia, essential hypertension, and uncontrolled type 2 diabetes mellitus, PAD is a plausible cause for leg pain, especially if the pain is exacerbated by walking (claudication).
  • Deep vein thrombosis (DVT) - The elevated D-dimer level raises concern for DVT, especially in the context of leg pain. Although D-dimer can be elevated in many conditions, it warrants further investigation for DVT.
  • Statin-induced myopathy - The patient's complaint of sharp pains around the chest area attributed to Rosuvastatin suggests the possibility of statin-induced myopathy, which could also contribute to leg pain if the muscles in the legs are affected.
• Do Not Miss Diagnoses:
  • Pulmonary embolism (PE) - Although the primary complaint is leg pain, the combination of elevated D-dimer and night sweats necessitates consideration of PE, a potentially life-threatening condition.
  • Aortic dissection - The sharp pains around the chest area could be indicative of an aortic dissection, a medical emergency that requires immediate attention.
  • Diabetic neuropathy - Given the patient's uncontrolled type 2 diabetes, diabetic neuropathy is a potential cause of leg pain and should not be overlooked.
• Rare Diagnoses:
  • Osteonecrosis - Although less common, osteonecrosis (especially in the context of steroid use or other specific risk factors not mentioned here) could be a cause of leg pain, particularly if the pain is localized to a joint.
  • Vasculitis - Various forms of vasculitis could potentially cause leg pain, especially if accompanied by systemic symptoms like night sweats and elevated inflammatory markers (not specifically mentioned but could be part of the differential).

Each of these diagnoses should be considered in the context of the patient's full medical history, physical examination, and further diagnostic testing as appropriate.