Urgent and Discreet

A 29-year-old woman, 7 weeks pregnant, complains of fatigue, nausea, and muscle aches, attributing them to her pregnancy. She's in an open marriage, with recent unprotected sex with multiple partners. History includes penicillin allergy and past chlamydia and gonorrhea treatment. No intravenous drug use reported. Five months ago, screening tests for various sexually transmitted infections, including chlamydia, gonorrhea, HIV, syphilis, hepatitis B, and hepatitis C, came back negative. On examination, the patient appears alert and oriented with no acute distress. Her temperature is 37.28°C, pulse: 95/min, blood pressure is 102/60 mm Hg, respiratory rate is 16 breaths/min. No scleral icterus, jaundice, or lymphadenopathy observed. Heart and lungs are clear. Abdomen is soft, nontender, with no hepatosplenomegaly. Trace pedal edema is present. Overall, examination is unremarkable.

Routine laboratory studies and a prenatal panel reveal these values:

Blood type                                                                        A+

Antibody screen                                                        Negative

White blood cell counts                                         6.8 × 10⁹/L (3.5–10.5)

Hemoglobin                                                             121 g/L (115–155)

Platelet count                                                           230 × 10⁹/L (130–380)

Creatinine                                                                 41 µmol/L (22–75)

Glucose level [random]                                        10 mmol/L (4.0–11.0)

Alanine aminotransferase                                        221 IU/L (17–63)

Aspartate aminotransferase                                     60 IU/L (15–37)

Rubella immunoglobulin G                                     84.7 IU/mL (> 10)

Her hepatitis C RNA polymerase chain reaction (PCR) test and Hepatitis C antibody test were reactive. Which of the following diagnoses is most likely,