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Hepatitis E — SCE Infectious Diseases MCQ

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ModerateHepatitisHepatitis ESCE Infectious Diseases

A 32-year-old pregnant woman (36 weeks) presents with jaundice, fever, and severe right upper quadrant pain. She recently returned from a visit to family in Pakistan. Anti-HEV IgM is positive and HEV RNA is detected. Her ALT is 2,800 U/L, INR is 2.1, and she is confused. What is the most critical immediate concern?

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Correct answer: E — Acute liver failure with high maternal mortality risk; urgent hepatology and obstetric involvement for consideration of early delivery

HEV genotype 1 (endemic in South Asia) in the third trimester of pregnancy carries 20–30% maternal mortality from fulminant hepatic failure. This patient has features of acute liver failure (coagulopathy, encephalopathy). There is no licensed antiviral for acute HEV. Management is supportive with urgent hepatology input, consideration of liver transplant, and obstetric involvement for timing of delivery. Ribavirin (used for chronic HEV in immunosuppressed patients) is teratogenic and contraindicated in pregnancy.

Reference: WHO 2022 – Hepatitis E; UKHSA 2023 – HEV clinical guidance