Prepare for the USMLE Step 1 exam with this detailed question about a 28-year-old woman experiencing severe abdominal pain and jaundice after returning from a trip to Southeast Asia. What family of viruses causes patchy necrosis of the liver? Test your knowledge and deepen your understanding of viral infections.
A 28-year-old Gravida 1 para 0 woman presents to the emergency department due to severe abdominal pain and jaundice. The patient’s symptoms started one week ago after returning from a trip to Southeast Asia. The patient’s partner had mild fatigue and jaundice but is currently improving. Initial bloodwork from the patient shows markedly elevated bilirubin and transaminases. The patient is admitted to the intensive care unit but eventually develops fulminant liver failure and dies. Autopsy shows patchy necrosis of the liver, and the cause of liver damage is determined to be viral hepatitis. The virus causing this patient’s hepatitis most likely belongs to which of the following viral families?
A. Hepevirus
B. Hepadna virus
C. Picornavirus
D. Flavivirus
E. Delta virus
Scroll down for the correct answer!
The correct answer to today’s USMLE® Step 1 Question is…
A. Hepevirus
Before we get to the Main Explanation, let’s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!
Incorrect Answer Explanations
B. Hepadna virus
Incorrect: Hepatitis B virus is a Hepadnavirus. This patient’s condition is most likely caused by hepatitis E, a Hepevirus.
C. Picornavirus
Incorrect: Hepatitis A virus is a Picornavirus. This patient’s condition is most likely caused by hepatitis E, a Hepevirus.
D. Flavivirus
Incorrect: Hepatitis C virus is a Flavivirus. It does not cause acute hepatitis. This patient’s condition is most likely caused by hepatitis E, a Hepevirus.
E. Delta virus
Incorrect: Hepatitis D virus is a Deltavirus that causes hepatitis in patients with coexisting hepatitis B. This patient’s condition is most likely caused by hepatitis E, a Hepevirus.
Main Explanation
This pregnant woman developed fulminant liver failure due to viral hepatitis. The patient’s partner probably also had the virus but only developed the mild disease. Given the travel history, the most likely cause is the hepatitis E virus. The Hepatitis E virus causes acute hepatitis similar to hepatitis A and is usually mild and resolves spontaneously. However, Hepatitis E can lead to devastating events in pregnant women, including fulminant hepatic failure, miscarriage, and stillbirth. Hepatitis E virus is transmitted via the fecal-oral route and is endemic in some areas in Africa, Southeast Asia, and the Middle East. It should be suspected in patients with hepatitis who have traveled to endemic areas recently.
Hepatitis E virus is an RNA virus that belongs to the Hepevirus family. It is a nonenveloped virus with an icosahedral capsid.
The other hepatitis viruses belong to different families and are as follows:
- Hepatitis A virus is a Picornavirus
- Hepatitis B virus is a Hepadnavirus
- Hepatitis C virus is a Flavivirus
- Hepatitis D virus is a deltavirus
Major Takeaway
Hepatitis E virus is an RNA virus that belongs to the Hepevirus family. It can lead to mild hepatitis in immunocompetent individuals but can have devastating effects on pregnant women (e.g., fulminant hepatitis).
References
- Waqar, S., Sharma, B., Koirala, J. Hepatitis e. [Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532278/
- Kamar, N., Dalton, H. R., Abravanel, F., & Izopet, J. (2014). Hepatitis E virus infection. Clinical microbiology reviews, 27(1), 116–138. https://doi.org/10.1128/CMR.00057-13
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