A 26-year-old woman in her third trimester of pregnancy presents with jaundice, vomiting, and ALT of 1800 U/L. Tests for hepatitis A, B, C, and autoimmune markers are negative. She deteriorates rapidly over 72 hours with coagulopathy and encephalopathy. The most likely causative agent is:

• A Hepatitis D virus
• B Herpes simplex virus
• C Cytomegalovirus
• D Hepatitis E virus ✓

Explanation

HEV genotype 1, endemic in India, causes fulminant hepatic failure in up to 20 percent of infections during the third trimester, the highest mortality of any hepatitis in pregnancy. CMV and HSV rarely cause this picture, and HDV requires concurrent HBV infection, which was excluded by negative testing.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.