Review Question - QID 104808

This patient presents with hepatitis E (HEV) which can cause fulminant hepatic failure in pregnant women.

HEV is a positive-sense, single-stranded RNA hepevirus which typically causes an acute infection similar to hepatitis A characterized by jaundice, fatigue, nausea, and vomiting. Like hepatitis A, it is transmitted fecal-orally, and is especially common with waterborne epidemics. In most patients, HEV is an acute, self-limited infection. However, in pregnant patients it can progress to fulminant liver failure. Those patients in the third trimester are at greatest risk with a mortality approaching 20%.

Shinde et al. performed a case control study to examine the clinical profile and maternal and fetal outcomes of acute hepatitis E in pregnancy. They concluded that there is significantly higher occurrence of hepatitis E infection in pregnant women than in non-pregnant women, which increases with gestation, associated fulminant hepatic failure, maternal mortality, and worse fetal outcome.

Sahai and Kiran review the causes and prognostic features of liver failure in pregnancy. They state that pregnant women appear to be more susceptible for HEV infection and the development of acute liver failure (ALF). The mortality of jaundiced pregnant women increased significantly with appearance of ALF, higher bilirubin, lower platelet count, higher international normalized ratio, and spontaneous delivery.

Figure A demonstrates scleral icterus which is commonly seen in HEV. Illustration A demonstrates the viral structure of HEV. Illustration B demonstrates the geographic distribution of HEV.

Incorrect answers:
Answers 1,2,4,5: These features are not known to increase the mortality of a patient with HEV.