Hepatitis C virus Quiz: Ace Your Exams

A 34-year-old woman presents to the primary care physician with malaise and fatigue. She reports that several months ago, she had an influenza-like illness where she had low-grade fevers, chills, nausea, and vomiting that self-resolved. She reports since that event, she has not felt back to her normal self. She reports she is otherwise healthy and does not use illicit drugs, drink alcohol, or smoke tobacco products. She works as a nurse in a large healthcare facility and recently traveled to Haiti for a medical mission trip. Temperature is 37 °C (98.6°F), pulse is 73/min, respirations are 14/min and blood pressure is 132/72 mmHg. Physical examination is unremarkable. She has screening labs performed which are notable for an ALT of 342 U/L and an AST of 221 U/L. She subsequently undergoes a liver biopsy which demonstrates lymphoid aggregates and areas of macrovesicular steatosis. This patient's clinical presentation was most likely the result of which of the following?