A 43-Year-Old Man Is Evaluated in the Hospital for a Medical

A 43-year-old man is evaluated in the hospital for a medical illness.  He has traveled to various countries on missionary trips and recently returned from South America.  The patient has no prior medical history and takes no medications.  His father has a history of alcohol dependence complicated by cirrhosis and portal hypertension.  A liver biopsy is performed, and light microscopy of the tissue demonstrates spotty hepatocyte necrosis and inflammatory cell infiltration, as shown in the image below. Which of the following is the most likely initial clinical presentation of this patient?

A) Clay-colored stools and osteoporosis
B) Fever, anorexia, and dark-colored urine
C) Prolonged pruritus and fatigue
D) Skin pigmentation and diabetes mellitus
E) Upper gastrointestinal bleeding and ascites

Correct Answer:

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