A 25-year-old man comes to his outpatient provider seeking evaluation of
jaundice. Two days ago, the patient participated in a marathon race. He had a similar episode in college after an episode of binge drinking. Past medical history is notable for
seasonal allergies and
hepatitis A infection, which he acquired one-year ago while travelling overseas. In the office, his temperature is 37.5°C (99.5°F),
blood pressure is 118/65 mmHg, and
pulse is 67/min. Physical examination shows
scleral icterus and diffuse jaundice. Cardiac, pulmonary, and abdominal exams are noncontributory.
Urinalysis reveals no significant findings. The patient’s blood work reveals the following findings:
| Laboratory value | Result |
| Hemoglobin | 14.2 mg.dL |
| Leukocyte count | 6,800/mm3 |
| Total bilirubin | 4.1 mg/dL |
| Conjugated bilirubin | 0.2 mg/dL |
| Alanine aminotransferase | 14 U/L |
| Aspartate aminotransferase | 17 U/L |
Which of the following best explains the underlying cause of this patient’s condition?
