A 26-year-old woman at 32 weeks gestation presents with jaundice, vomiting, and deranged coagulation (INR 2.8) over 10 days. ALT is 3200 IU/L. She lives in rural northern India and drinks untreated well water. Which viral agent is most likely responsible?

• A Hepatitis E virus ✓
• B Hepatitis B virus
• C Hepatitis C virus
• D Hepatitis A virus

Explanation

Hepatitis E virus, genotype 1 endemic to the Indian subcontinent, causes fulminant hepatic failure in pregnant women with mortality approaching 20 percent, highest in the third trimester. Feco-oral transmission through contaminated water fits the history. Hepatitis D rarely causes such severe disease in pregnancy, and hepatitis C does not cause acute icteric fulminant hepatitis in this setting.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.