A 20 year old male presented with jaundice for the past 2 weeks. His liver function tests revealed serum bilirubin to be 0.9 mg/dL, SGOT/SGPT to be 1240/1450 IU. He was found to be positive for HBsAg and IgM anti-HEV antibodies and negative for 1gM anti HBc. The most likely diagnosis is

**Core Concept**
The patient's presentation with jaundice, elevated liver enzymes, and positive HBsAg indicates a liver infection. However, the presence of IgM anti-HEV antibodies suggests an acute hepatitis E infection, which is a zoonotic disease caused by the hepatitis E virus (HEV).

**Why the Correct Answer is Right**
The correct diagnosis is acute hepatitis E infection. The presence of IgM anti-HEV antibodies indicates a recent infection, whereas the absence of IgM anti-HBc antibodies suggests that the patient is not infected with hepatitis B virus (HBV). The elevated liver enzymes (SGOT/SGPT) and jaundice are consistent with acute hepatitis E infection. HEV is typically transmitted through the fecal-oral route, and the patient may have acquired the infection through contaminated food or water.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is not provided.
**Option B:** This option is not provided.
**Option C:** This option is not provided.
**Option D:** This option is not provided.

**Clinical Pearl / High-Yield Fact**
Acute hepatitis E infection is a significant cause of acute liver failure in developing countries, particularly in areas with poor sanitation and hygiene. The infection is often transmitted through contaminated water or food, and the virus can be shed in the stool of infected individuals.

**Correct Answer:** D.

✓ Correct Answer: B. Super infection of hepatitis E virus with chronic hepatitis B infection