Underrecognized Zieve's syndrome, A case report

Gosal, Kiranpreet; Singh, Pratishtha; Westbrook, Katherine; Carter, Meg Kanoy

doi:10.1016/j.amsu.2021.102464

Cited by 4 publications

(7 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ZS is a rare disease among chronic alcohol abusers. It is characterized by the triad of Coombs-negative hemolytic anemia, cholestatic jaundice, and transient hyperlipidemia in patients with a history of alcohol abuse and liver disease [ 1 ]. The mechanism of hemolysis is unclear, but it has been related to an accumulation of polyunsaturated fatty acid and cholesterol inside RBC membranes [ 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our case presents a patient with characteristics similar to acute alcoholic hepatitis (AAH) with non-specific symptoms of jaundice, elevated bilirubin, elevated hepatic enzymes, abnormal INR, and abnormal lipid panel, in addition to an ultrasound consistent with hepatic steatosis [ 1 ]. However, it is essential to consider that ZS can also present with non-specific symptoms besides the classic triad.…”

Section: Discussionmentioning

confidence: 99%

“…Zieve’s syndrome (ZS) is a rare condition that occurs in the setting of alcohol-related liver disease, characterized by hemolytic anemia, hyperlipidemia, and jaundice, especially found in heavy alcohol users after a binge drink [ 1 , 2 ]. Hyperlipidemia can be challenging as levels can fluctuate and, in certain cases, lipid levels can be normal, which is an atypical presentation of this syndrome [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Case of Zieve’s Syndrome With the Development of Delirium Tremens

Nieto¹,

Martinez²,

Narvaez³

et al. 2023

Cureus

View full text Add to dashboard Cite

A 50-year-old man presented to the emergency department with dark urine and altered mental status. Upon examination, the patient was found to be jaundiced with normal vitals. Laboratory investigation demonstrated macrocytic anemia and abnormal liver function tests. During his hospitalization, he developed delirium tremens in addition to the discovery of acute hemolytic anemia, hypercholesterolemia, and hypertriglyceridemia. Therefore, he was diagnosed with Zieve's syndrome (ZS), a rarely reported disease characterized by hemolytic anemia, cholestatic jaundice, and transient hyperlipidemia. Physicians encountering acute hemolytic anemia in a patient with concomitant acute liver injury should consider ZS as a differential diagnosis, as prompt recognition of the syndrome can help prevent unnecessary procedures and therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Case of Zieve’s Syndrome With the Development of Delirium Tremens

Nieto¹,

Martinez²,

Narvaez³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…In one case, a patient with triglyceride levels >4,000 mg/dL was treated with plasmapheresis [ 9 ]. Patients with Zieve syndrome who have a history of pancreatitis or intracerebral hemorrhage should be evaluated for plasmapheresis, as elevated lipid levels are known to result in worse outcomes in patients with pancreatitis or intracerebral hemorrhage [ 3 , 10 ]. Importantly, corticosteroids have not been shown to be beneficial in treating Zieve syndrome and should be avoided [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis is made by the presence of hemolytic anemia, jaundice, and transient hyperlipidemia in the setting of chronic alcohol use, although lipid levels are normal in half of all patients [ 2 ]. Treatment consists of abstinence from alcohol and blood transfusions as necessary, and most patients recover within 4-6 weeks after alcohol cessation [ 2 , 3 ]. While there are many causes of anemia in chronic liver disease, Zieve syndrome is distinct in that it is hemolytic.…”

Section: Introductionmentioning

confidence: 99%

Zieve Syndrome in a Patient With Hepatitis C

Haider¹,

Salabei²,

Hashmi³

et al. 2022

Cureus

View full text Add to dashboard Cite

Zieve syndrome is a very rare syndrome that presents as a triad of hemolytic anemia, jaundice, and transient hyperlipidemia in patients with alcoholic liver disease. Herein, we present a case of a 30-year-old female with alcoholic liver disease and chronic hepatitis C. She presented with altered mental status and profound jaundice and was subsequently found to have acute hemolytic anemia due to Zieve syndrome. All other causes of hemolytic anemia were ruled out. She abstained from alcohol and received blood transfusions as needed, leading to the improvement of her anemia. This case highlights the need for more medical education about Zieve syndrome as the under-recognition of the disease can lead to unnecessary treatments. We review the existing literature to explain the epidemiology, pathogenesis, diagnosis, and treatment of Zieve syndrome. This case represents a rare presentation of Zieve syndrome in a patient with hepatitis C, and we have hypothesized a possible role of chronic hepatitis C infection in its pathophysiology.

show abstract

An unusual case of Zieve's syndrome in a 36‐year‐old male with latent autoimmune diabetes of adult and disseminated intravascular coagulation

Zalavadiya,

Bhatt,

Nagori

et al. 2024

Clinical Case Reports

View full text Add to dashboard Cite

Key Clinical MessageZieve's syndrome, associated with chronic alcoholism, manifests as hemolytic anemia, transient hyperlipidemia, and cholestatic jaundice. Key symptoms comprise nausea, abdominal pain, and jaundice. Diagnosis relies on recognizing the triad in those with an alcohol use history. Supportive management includes blood transfusions and alcohol cessation. The exact pathophysiology remains uncertain, with hypotheses ranging from alcohol‐induced liver damage to autoimmune processes. The report emphasizes diagnostic complexities, particularly when concurrent with autoimmune disorders such as latent autoimmune diabetes of adults or complicated by disseminated intravascular coagulation (DIC). A 36‐year‐old male with latent autoimmune diabetes of adults and an 18‐year history of chronic alcoholism presented with yellowish skin discoloration, abdominal pain, and distension. Physical examination revealed signs of anemia, jaundice, pedal edema, hepatomegaly, splenomegaly, and abdominal tenderness. Over eight admissions, multiple tests revealed severe anemia, thrombocytopenia, elevated bilirubin, and positive autoantibodies. Treatment for suspected autoimmune hepatitis showed no improvement. Subsequent examinations indicated DIC, altered liver function, and cirrhosis progression. A confirmed diagnosis of Zieve's syndrome was made. Upper gastrointestinal endoscopy was done to check for esophageal varices which were banded. The patient was subsequently managed on supportive treatment with multiple blood transfusions and abstinence from alcohol. Prompt recognition of Zieve's syndrome is crucial to avoid unnecessary interventions. Alcohol cessation is the keystone of treatment, emphasizing the need to raise awareness among practitioners. This case points toward the importance of comprehensive evaluation, serial investigations, and multidisciplinary collaboration for accurate diagnosis and management. Further research is needed to enhance understanding and optimize therapeutic strategies.

show abstract

Underrecognized Zieve's syndrome, A case report

Cited by 4 publications

References 6 publications

A Case of Zieve’s Syndrome With the Development of Delirium Tremens

A Case of Zieve’s Syndrome With the Development of Delirium Tremens

Zieve Syndrome in a Patient With Hepatitis C

An unusual case of Zieve's syndrome in a 36‐year‐old male with latent autoimmune diabetes of adult and disseminated intravascular coagulation

Contact Info

Product

Resources

About