Most of the family
physicians know the common causes of bilateral oedema but the most
common unilateral oedema of leg seen by every family physician more
or less daily, is due to DVT (Deep vein thrombosis).
In this article, I want to mention a collection of rare causes, seen
in my practice over the last 40 years. You might remember them in
an occasional patient who comes to you where no diagnosis has been
made. The causes are as follows :
1. Hansen’s disease : On careful and detailed examination, skin
signs can be elicited.
2. Polyarteritis nodosa : Where the patient in addition may be having
hypertension, fever, ill health, joint pains, abnormal urine or any
other systemic disorder including a CNS involvement like peripheral
neuritis (often confirmed as mononeuritis multiplex on EMG).
3. Wagner’s disease : The patient has systemic disease like
TB and a bad shadow on X-ray chest (sputum negative for AFB or TB
PCR), joint pains etc, and a positive ANCA test.
4. Behcet’s Syndrome : Patient has ulcers in the mouth or genital
area with ill health and skin lesions specially erythema nodosum.
5. Anti
phospholipid syndrome in a straightforward patient having DVT and
the blood test reveals either cardiolipin antibodies or a lupus anticoagulant.
6. Angio-oedema which comes and goes and increases or decreases, may
be associated with redness or itching.
7. Lymphoedema which more often is non pitting but could be less pitting.
8. RSD (Reflex Sympathetic Dystrophy) syndrome where along with pain
in the shoulder or arm, the patient has oedema, muscle weakness and
skin signs of discoloration (vasomotor in origin).
9. Iatrogenic specially in a patient taking amlodipine group of drugs
though in such cases oedema is bilateral (very often).
10. In a patient of acute gout along with severe pain in one of the
joints, redness of skin, fever and tenderness, oedema is often noticed.
11. Acute Cellulitis-Infact, the presentation of this condition is
similar to that of acute gout. It could be often misdiagnosed.
12. Finally, in a patient who comes with the symptom of so-called
oedema, which he shows by doing pitting over the shin of the tibia,
the cause could be loss of elasticity of skin, due to aging (especially
in patients more than 60 years old).
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital,
Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital,
Mumbai 400 008.
