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A 43-year-old man is found wandering in the street in winter and is brought to the emergency department by a passing motorist. The patient is confused and unable to provide any additional history. He has no previous hospital records. On examination, there is mild hypothermia at 35 C (95 F), but vital signs are otherwise normal. The patient appears disheveled and lethargic but follows commands. Oral mucosa is moist and he has extensive dental caries. He has no cervical lymphadenopathy, but there is bilateral nontender submandibular swelling consistent with salivary gland enlargement. Which of the following is the most likely cause of this latter finding?
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