Unique Variant of Zieve Syndrome With a Normal Reticulocyte Count

Abstract

Zieve syndrome is a rare diagnosis seen in patients with chronic alcohol use which consists of a distinct clinical triad of hyperlipidemia, hemolytic anemia, and jaundice. Patients typically have an elevated reticulocyte count due to the hemolytic nature of the anemia. We present the case of a 44-year-old female who was discovered to have an unusual variant of Zieve syndrome with a normal reticulocyte count, which was believed to be due to suppression of bone marrow from excessive alcohol consumption. She was treated with steroids and complete alcohol cessation, with remarkable improvement on subsequent follow-up. An exhaustive literature review of 31 documented cases of Zieve syndrome was conducted to better understand the clinical presentation and overall prognosis of these patients. This case report and literature review aimed to improve patient outcomes through increased recognition of this underrecognized syndrome.

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

“…This can lead to harmful effects on hematopoietic stem cells, suppressing their function and resulting in impaired generation of the three main types of blood cells—white blood cells, red blood cells, and platelets. Consequently, the levels of these crucial blood components are reduced 7 . This may support the findings of persistent anemia and thrombocytopenia in this case of Zieve's syndrome.…”

“…Consequently, the levels of these crucial blood components are reduced. 7 This may support the findings of persistent anemia and thrombocytopenia in this case of Zieve's syndrome.…”

“…In this scenario, the patient's coexisting autoimmune disorder, hemolytic anemia, hepatobiliary dysfunction, chronic alcoholism, and esophageal varices collectively supported the diagnosis of Zieve's syndrome. Also, as in our case the stool occult blood testing were negative, another case report stated that medical professionals should maintain a strong clinical suspicion for Zieve syndrome when dealing with individuals who have a confirmed record of excessive alcohol consumption and exhibit symptoms like hemolytic normocytic anemia and hyperbilirubinemia and no evidence of upper GI bleeding 7,8 …”

“…Also, as in our case the stool occult blood testing were negative, another case report stated that medical professionals should maintain a strong clinical suspicion for Zieve syndrome when dealing with individuals who have a confirmed record of excessive alcohol consumption and exhibit symptoms like hemolytic normocytic anemia and hyperbilirubinemia and no evidence of upper GI bleeding. 7,8 The presence of autoimmune DM (LADA) is an unusual finding associated with the case of Zieve's syndrome. This may be the first case reporting the co-occurrence of Hb 4.9 6.9 6.9 7.2 6.9 Zieve's syndrome and autoimmune DM (LADA).…”

“…Also, as in our case the stool occult blood testing were negative, another case report stated that medical professionals should maintain a strong clinical suspicion for Zieve syndrome when dealing with individuals who have a confirmed record of excessive alcohol consumption and exhibit symptoms like hemolytic normocytic anemia and hyperbilirubinemia and no evidence of upper GI bleeding. 7 , 8 …”