26th April 2024

A 45-year-old man presents with a 2-week history of fatigue, nausea, and abdominal discomfort.

A 45-year-old man presents with a 2-week history of fatigue, nausea, and abdominal discomfort. Over the last few days, his urine has become darker, and his skin and eyes appear yellow. He has a history of occasional recreational drug use and unprotected sexual encounters. He denies any recent travel or consumption of undercooked seafood.

On examination, his temperature is 37.5°C, pulse rate 88 bpm regular, and BP 120/80 mmHg. His sclerae are icteric, and there is tenderness in the right upper quadrant of the abdomen. His liver is palpable 3 cm below the costal margin. There are no rashes or joint swellings.

Which of the following is the most likely cause of his condition?