Ans. is 'b' i.e., Hepatitis B Fulminant hepatits* The most feared complication of viral hepatitis is fulminant hepatitis (massive hepatic necrosis); fortunately, this is a rare event.* Fulminant hepatitis is primarily seen in hepatitis B and D, as well as hepatitis E, but rare fulminant cases of hepatitis A occur primarily in older adults and in persons with underlying chronic liver disease, including, according to some reports, chronic hepatitis B and C.* Hepatitis B accounts for > 50% of fulminant cases of viral hepatitis, a sizable proportion of which are associated with HDV infection and another proportion with underlying chronic hepatitis C.* Fulminant hepatitis is hardly ever seen in hepatitis C, but hepatitis E, as noted above, can be complicated by fatal fulminant hepatitis in 1-2% of all cases and in up to 20% of cases in pregnant women.* Patients usually present with signs and symptoms of encephalopathy that may evolve to deep coma.* The liver is usually small and the PT excessively prolonged.* The combination of rapidly shrinking liver size, rapidly rising bilirubin level, and marked prolongation of the PT, even as aminotransferase levels fall, together with clinical signs of confusion, disorientation, somnolence, ascites, and edema, indicates that the patient has hepatic failure with encephalopathy.* Cerebral edema is common; brainstem compression, gastrointestinal bleeding, sepsis, respiratory failure, cardiovascular collapse, and renal failure are terminal events.* The mortality rate is exceedingly high (> 80% in patients with deep coma), but patients who survive may have a complete biochemical and histologic recovery.* If a donor liver can be located in time, liver transplantation may be life- saving in patients with fulminant hepatitis.