A 35-year-old pregnant woman in her third trimester presents with acute jaundice, fever, and altered sensorium. ALT is 1800 U/L, total bilirubin 12 mg/dL, and INR is 2.1. Which organism is most likely responsible?
- A Hepatitis A virus
- B Hepatitis E virus ✓
- C Hepatitis B virus
- D Herpes simplex virus
Correct answer: B. Hepatitis E virus
Explanation
Hepatitis E virus (HEV), particularly genotype 1, causes acute liver failure with high mortality (15 to 25%) in pregnant women during the third trimester. This is a well-established epidemiological feature in the Indian subcontinent where HEV is endemic. The clinical picture of acute hepatitis with coagulopathy and encephalopathy in late pregnancy is characteristic. HAV and HBV do not have this predilection for fulminant course in pregnancy. HSV hepatitis is rare and typically presents with fever and very high transaminases but is not pregnancy-specific.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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