A 34-year-old woman, G1P0, at 34 weeks gestation comes to the physician for a 1-week history of progressive yellowing of the eyes, fatigue, fever, and RUQ pain. She recently returned from visiting her family in Tibet. Four days later, her transaminases are markedly elevated. Partial thromboplastin time is elevated. Serum bile acids are normal. She does not report itchy skin. She undergoes Caesarean section and a liver transplantation. Which of the following is the most likely explanation for this patient’s presentation?
A) Acute hepatitis A infection
B) Intrahepatic cholestasis of pregnancy
C) Intravenous drug use
D) Shift from Th1 to Th2 immunity
E) Stimulation of CD8 immunity
