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Snapshot
  • A 28-year-old woman is brought by her husband to the emergency department with nausea, malaise, pruritus, and severe abdominal pain. Her symptoms began yesterday and have since worsened. Her husband reports that she appears "yellow" and has been mildly confused. She is currently pregnant at 29 weeks gestation and recently emigrated from India to the United States.  Physical examination demonstrates a jaundiced woman with scleral icterus. She is oriented to person but not to place or time. There is tenderness to palpation in the right upper quadrant of the abdomen with hepatomegaly. Laboratory testing is significant for elevated alanine and aspartate aminotransferases and anti-HEV IgM antibodies.
Introduction
  • Classification
    • an Orthohepevirus from the family Hepeviridae
      • a nonenveloped, single-stranded, positive-sense RNA virus that has an icosahedral capsid
  • Epidemiology
    • incidence
      • causes clinically apparent hepatitis in
        • India
        • Asia
        • Africa
        • Central America
  • Transmission
    • fecal-oral
    • waterborne secondary to fecal contamination
  • Pathogenesis
    • not clear but believed to be immune-mediated
  • Prognosis
    • usually self-limited in acute infection
    • can be fatal in pregnant women 
      • the highest risk in the 3rd trimester, leading to fulminant hepatic failure
Presentation
  • Symptoms
    • nausea and vomiting
    • abdominal pain
    • anorexia
  • Physical exam
    • scleral icterus
    • jaundice
    • hepatomegaly
Studies
  • Serologic testing
    • presence of anti-HEV antibodies
    • elevate aminotransferases
Differential
  • Hepatitis A infection
    • differentiating factor
      • presence of anti-hepatitis A antibodies in serological testing
  • Hepatitis B infection
    • differentiating factor
      • presence of anti-hepatitis B antibodies in serological testing
  • Hepatitis C infection
    • differentiating factor
      • presence of anti-hepatitis C antibodies in serological testing
Treatment
  • Conservative
    • supportive management
      • indication
        • mainstay of treatment
Complications
  • Fulminant hepatic failure in pregnancy 
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