SHM Converge Scientific Abstract ePoster Gallery-One Leg to Stand On: Differentiating the Cause of Unilateral Leg Pain and Swelling

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A healthy 21-year-old woman presented with one week of worsening bilateral calf pain, right leg swelling, weakness, and initially absent palpable pedal pulses with a cool right lower extremity. A systematic evaluation was performed to rule out urgent causes of unilateral leg swelling and pain. Doppler ultrasound showed no DVT, CT angiogram showed no arterial thrombosis, and MRI demonstrated edema along the muscular fascia and intramuscular fascial planes consistent with fasciitis.<br /><br />Her symptoms began after a routine 12-hour nursing shift without unusual exertion. Relevant history included streptococcal pharyngitis treated with amoxicillin two weeks earlier, influenza vaccination one day before symptom onset, recent travel to the Dominican Republic, and a maternal family history of SLE and Hashimoto’s thyroiditis. Physical exam showed normal vital signs, transiently diminished pulses in the right foot, coolness of the extremity, pinpoint erythematous papules that had resolved by presentation, and bilateral lower extremity weakness limited by pain.<br /><br />Laboratory testing showed normal CBC and CK, mildly elevated CRP and ESR, elevated ASO titer, positive ANA at 1:320 with a speckled pattern, and positive RNP antibody. Infectious studies, including STI screening and Lyme testing, were negative. Rheumatology later felt the presentation was not consistent with a defined connective tissue disease, and EMG was normal.<br /><br />The patient improved with supportive care, was discharged using a walker, and later continued to have right leg weakness requiring a cane. Overall, this case illustrates the broad differential diagnosis of unilateral leg pain and swelling and the importance of excluding life-threatening vascular causes while considering inflammatory, infectious, post-vaccine, neurologic, and rheumatologic etiologies. The underlying cause of her fasciitis and weakness remains unclear, and further outpatient evaluation is ongoing.

Asset Subtitle

Diane Hassanieh

Meta Tag

Author List Diane Hassanieh, Mariana Colussi-Pelaez, Weijen Chang

Category Clinical Vignettes

Concept Unilateral Leg Swelling

Concept Acute Limb Ischemia

Concept Deep Vein Thrombosis

Concept Leg Pain

Concept Doppler Ultrasound

Distinguished Non-Finalist

Presenter Organization Baystate Medical Center

Presenting Author Diane Hassanieh

Track Pediatric

Keywords

bilateral calf pain

unilateral leg swelling

fasciitis

MRI edema

Doppler ultrasound

arterial thrombosis

positive ANA

RNP antibody

streptococcal pharyngitis

differential diagnosis

Unilateral Leg Swelling

Acute Limb Ischemia

Deep Vein Thrombosis

Leg Pain

Doppler Ultrasound