Review Question - QID 212503

A 27-year-old woman presents to her primary care physician for minor aches and pains in her bones and muscles. She states that these symptoms have persisted throughout her entire life but have worsened recently when she moved to attend college. The patient is physically active, and states that she eats a balanced diet. She is currently a full-time student and is sexually active with 1 partner. She states that she has been particularly stressed lately studying for final exams and occasionally experiences diarrhea. She has been taking acyclovir for a dermatologic herpes simplex virus infection with minimal improvement. On physical exam, the patient exhibits 4/5 strength in her upper and lower extremities, and diffuse tenderness over her limbs that is non-specific. Laboratory values are ordered as seen below:

Serum:
Na+: 144 mEq/L
Cl-: 102 mEq/L
K+: 4.7 mEq/L
HCO3-: 24 mEq/L
Ca2+: 5.0
Urea nitrogen: 15 mg/dL
Glucose: 81 mg/dL
Creatinine: 1.0 mg/dL
Alkaline phosphatase: 225 U/L
Aspartate aminotransferase (AST, GOT): 11 U/L
Alanine aminotransferase (ALT, GPT): 15 U/L

Which of the following is most likely associated with this patient’s presentation?