Differential Diagnosis for 60-year-old Female with Fatigue and Left Toe Nail Pain
Single Most Likely Diagnosis
- Onychomycosis: Given the patient's complaint of left toenail pain, onychomycosis (fungal infection of the nail) is a common condition, especially in diabetic patients, which can cause pain and discomfort.
- Diabetic Neuropathy: The patient's history of diabetes mellitus and complaint of fatigue could be related to diabetic neuropathy, which is a common complication of diabetes and can cause pain, numbness, and fatigue.
Other Likely Diagnoses
- Peripheral Artery Disease (PAD): The patient's history of hypertension, hyperlipidemia, and diabetes mellitus increases her risk for PAD, which can cause fatigue and pain in the legs, including the toes.
- Iron Deficiency Anemia: Fatigue is a common symptom of iron deficiency anemia, which can be caused by various factors, including menstrual bleeding, gastrointestinal bleeding (e.g., from hemorrhoids), or poor dietary intake.
- Hypothyroidism: Fatigue is a common symptom of hypothyroidism, which can be associated with other symptoms such as dry skin, hair loss, and cold intolerance.
Do Not Miss Diagnoses
- Osteomyelitis: Although less likely, osteomyelitis (bone infection) can cause pain and swelling in the toes and can be a serious complication if left untreated, especially in diabetic patients.
- Deep Vein Thrombosis (DVT): The patient's history of edema and fatigue increases her risk for DVT, which can cause pain and swelling in the legs and can be life-threatening if not treated promptly.
- Cellulitis: Bacterial infection of the skin and soft tissues, which can cause pain, redness, and swelling in the affected area, including the toes.
Rare Diagnoses
- Sickle Cell Disease: Although rare, sickle cell disease can cause fatigue, pain, and swelling in the toes due to vaso-occlusive crises.
- Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet, which can be associated with various underlying conditions, including myeloproliferative disorders.
- Complex Regional Pain Syndrome (CRPS): A rare condition characterized by chronic pain, inflammation, and sensitivity in one limb, which can be triggered by injury or trauma.