Differential Diagnosis for Chronic Steroid Abuse

Single Most Likely Diagnosis

• Cushing's Syndrome: The patient's symptoms, including weight gain, non-healing ulcers, joint deformity, abdominal distension, and buffalo hump, are classic signs of Cushing's syndrome, which can be caused by long-term use of corticosteroids like prednisolone.

Other Likely Diagnoses

• Osteoporosis: Chronic steroid use can lead to osteoporosis, which may cause joint deformity and increased risk of fractures.
• Steroid-Induced Diabetes: The patient's weight gain and steroid use increase the risk of developing diabetes, which can contribute to non-healing ulcers.
• Hypertension: Chronic steroid use can cause hypertension, which may contribute to the patient's symptoms, including abdominal distension.

Do Not Miss Diagnoses

• Peptic Ulcer Disease: Steroid use can increase the risk of peptic ulcers, which can be life-threatening if perforation occurs.
• Infections: The patient's immunosuppressed state due to chronic steroid use increases the risk of infections, including those that can cause non-healing ulcers.
• Malignancy: Although less likely, the patient's non-healing ulcers and weight loss could be indicative of an underlying malignancy.

Rare Diagnoses

• Adrenal Insufficiency: Although the patient is taking exogenous steroids, adrenal insufficiency can occur if the patient suddenly stops taking the medication or has an underlying adrenal gland disorder.
• Pituitary Tumor: A rare cause of Cushing's syndrome, a pituitary tumor could be responsible for the patient's symptoms, although this would be less likely given the patient's history of chronic steroid use.