Differential Diagnosis for Feverish Sensation in Legs without True Fever

• Single most likely diagnosis:
  • Nocturnal leg cramps: This condition is characterized by sudden, intense muscle contractions, often occurring at night, which can cause a feverish sensation in the legs due to increased muscle metabolism and lactic acid production.
• Other Likely diagnoses:
  • Restless Legs Syndrome (RLS): A disorder that causes a strong urge to move one's legs, often accompanied by uncomfortable sensations such as burning, itching, or feverish feelings, typically worsening in the evening or when resting.
  • Poor circulation: Reduced blood flow to the legs can lead to sensations of warmth or feverishness due to decreased oxygen delivery and increased metabolic byproducts.
  • Neuropathy: Damage to the peripheral nerves can cause abnormal sensations, including feverish feelings, in the legs due to disrupted nerve signaling.
• Do Not Miss diagnoses:
  • Deep Vein Thrombosis (DVT): A blood clot in the deep veins of the legs can cause warmth, swelling, and a feverish sensation, which is a medical emergency due to the risk of pulmonary embolism.
  • Cellulitis: A bacterial skin infection that can cause redness, warmth, swelling, and a feverish sensation in the affected leg, requiring prompt antibiotic treatment to prevent serious complications.
  • Peripheral artery disease (PAD): Severe narrowing or blockage of the arteries supplying the legs can lead to decreased blood flow, causing feverish sensations, pain, and potentially leading to gangrene if not addressed.
• Rare diagnoses:
  • Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet, which can also cause a feverish sensation in the legs.
  • Complex Regional Pain Syndrome (CRPS): A chronic pain condition that can cause intense burning or feverish sensations in the legs, often following an injury or trauma.
  • Lymphedema: Chronic swelling of the legs due to impaired lymphatic drainage can lead to sensations of warmth or feverishness, although this is less common.