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Hepatitis E — SCE Infectious Diseases MCQ

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ModerateHepatitisHepatitis ESCE Infectious Diseases

A 28-year-old pregnant woman (32 weeks gestation) presents with jaundice and malaise. She recently returned from a trip to visit family in Pakistan. Her hepatitis E IgM is positive and HEV RNA is detected. ALT is 1,200 U/L. What is the most concerning complication in this clinical scenario?

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Correct answer: D — Fulminant hepatic failure with high maternal mortality

Hepatitis E virus (HEV, particularly genotype 1, endemic in South Asia) in pregnancy carries a very high risk of fulminant hepatic failure with maternal mortality rates of 20–30%, particularly in the third trimester. This is in contrast to genotype 3 HEV (endemic in Europe) which is typically milder but can cause chronic infection in immunosuppressed patients. There is no specific antiviral treatment for acute HEV in pregnancy; management is supportive with liver transplant consideration for acute liver failure.

Reference: WHO 2022 – Hepatitis E guidelines; UKHSA 2023 – HEV guidance for clinicians