**Question:** A young pregnant woman presents with fulminant hepatic failure. The most likely aetiological agent is -

A. Hepatitis B
B. Hepatitis C
C. Autoimmune hepatitis
D. Wilson's disease

**Correct Answer:** **D. Wilson's disease**

**Core Concept:** Fulminant hepatic failure is a severe and rapidly progressive liver disease with high mortality rate. It is characterized by acute liver dysfunction, coagulopathy, and systemic complications.

**Why the Correct Answer is Right:** Wilson's disease is a rare autosomal recessive disorder caused by mutations in the ATP7B gene, which leads to copper accumulation in the liver and brain. In pregnancy, the liver's ability to detoxify and eliminate toxic substances is compromised, increasing the risk of Wilson's disease manifestations. The disease typically presents with acute liver failure, neuropsychiatric symptoms, and Kayser-Fleischer rings in the cornea, which are characteristic findings in Wilson's disease patients.

**Why Each Wrong Option is Incorrect:**

A. Hepatitis B and C are common causes of acute liver failure, but they usually present with chronic liver disease rather than fulminant hepatic failure.

B. Autoimmune hepatitis is a chronic cause of liver inflammation and fibrosis, not typically presenting with fulminant hepatic failure.

C. Wilson's disease is the correct answer as it causes acute liver failure in pregnancy, while the other options generally present with chronic liver disease.

**Clinical Pearl:** In pregnant patients presenting with acute liver failure, Wilson's disease should be considered in the differential diagnosis, especially when there are concomitant neuropsychiatric symptoms and Kayser-Fleischer rings. Prompt diagnosis and treatment can lead to improved outcomes for both the mother and fetus.