A 26-year-old woman in her third trimester of pregnancy presents with 5 days of jaundice, nausea, and right upper quadrant discomfort. She has no history of drug intake or alcohol use. ALT is 1450 U/L, bilirubin 9 mg/dL, and INR is 2.4. She progresses to encephalopathy within 48 hours. Which virus is the most likely cause?
- A Hepatitis A virus
- B Hepatitis E virus ✓
- C Hepatitis B virus
- D Cytomegalovirus
Correct answer: B. Hepatitis E virus
Explanation
Hepatitis E, an enterically transmitted RNA virus, causes a self-limited illness in most adults but carries a mortality of up to 20 to 25 percent when acquired in the third trimester, typically from fulminant hepatic failure. Hepatitis A rarely causes fulminant failure in pregnancy and does not show this trimester-specific predilection. Hepatitis C causes fulminant failure but is parenterally transmitted and unrelated to gestational age.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.