History

Sara, a 38 year old mother of 2, presented with a complaint of severe bilateral leg and arm pain for the past 2 days. She states the pain began a few hours after working out at the gym. She reports that she has been training for a trail marathon with weekly mileage of approximately 40 – 50 miles.  In the past week she has added weight training to round out her routine. She states the pain is getting quite severe and seems progressive. All movement hurts and there is some pain present even at rest. The pain has not disturbed her sleep. In fact Sara states she has been very tired the past 2 days, sleeping over 10 hours both previous nights as well as napping during the day. She reports that she is also coming down with a cold or the flu, noting fever, lethargy and nausea.

Sara had been a patient in your practice a number of years prior. When asked about her family she at first stated that everyone was well. She then admitted that her husband has just recently moved out and was filing for divorce. During the history Sara seemed at times a bit agitated while also unfocused. Several times she asked for a question to be repeated.

Question: Based on the history what are some differential diagnoses you are considering?