<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 66-year-old man presents to the outpatient department complaining of a rash similar to the ones in the image. The skin lesions have been present for about 2 weeks. It is present in the buttocks and both inferior limbs. There is no association of skin lesions with exposure to sunlight or medication use. The patient also reports joint pain affecting the distal and proximal joints in both the upper and lower limbs. The joint pain has been present for about a week and seems to improve with Tylenol use. The patient is a retired armed force personnel with an extensive tour of overseas duty. He received blood transfusion following a career-ending injury about 30 years ago. He denies alcohol and tobacco use. He is currently in a monogamous relationship with his wife for 40 years. His past medical history is significant for hypertension controlled on Enalapril. Physical examination shows mild pallor, multiple palpable purpuric lesions with occasional ulcerations bilaterally in the upper and lower limbs. Pulse rate is 88min and blood pressure is 12882 mm Hg. Laboratory test findings are:HIV I and II antibodies negativeRheumatoid factor positiveHepatitis C antigen positiveHepatitis B surface antigen positiveHepatitis B antibody positiveAnti-neutrophil antibody positiveHematocrit 38Which of the following mechanisms is most likely responsible for his clinical presentation?? A: Cyto-proliferative effect of HCV on hepatocytes, B: Excessive uroporphyrinogen caused by HCV induced decarboxylase deficiency, C: Defective hepatic removal of IgA caused by chronic HCV, D: Monoclonal expansion of IgM caused by benign neoplasia, E: Virus-induced clonal expansion of autoreactive B lymphocytes,  <response>: This is a clinical vignette describing a 66-year-old man with a rash, joint pain, and several positive lab findings including rheumatoid factor, HCV, HBV, and anti-neutrophil antibodies. The key findings are the palpable purpuric rash, joint pain, HCV infection, and positive rheumatoid factor and anti-neutrophil antibodies. This presentation is most consistent with cryoglobulinemic vasculitis secondary to chronic HCV infection. The purpuric rash and joint pain indicate vasculitis. The positive rheumatoid factor and anti-neutrophil antibodies support an autoimmune process triggered by the chronic HCV infection. Choices A, B, and D do not explain the clinical presentation. Choice C may play a role but is not the primary mechanism. Choice E, virus-induced clonal expansion of autoreactive B lymphocytes, is the most likely explanation for this patients cryoglobulinemic vasculitis.E: Virus-induced clonal expansion of autoreactive B lymphocytes 