SHM Converge Scientific Abstract ePoster Gallery-Unmasking Zieve Syndrome: A Case Report

Pdf Summary

This case report describes a 35-year-old man with chronic alcohol use disorder, tobacco use, and malnutrition who presented with several days of jaundice. He denied abdominal pain, fever, nausea, vomiting, or bleeding symptoms. Examination showed lethargy and diffuse jaundice, while CT imaging demonstrated hepatomegaly and hepatic steatosis.<br /><br />Laboratory findings were notable for severe anemia and evidence of hemolysis: hemoglobin 4.8 g/dL, elevated LDH, low haptoglobin, macrocytosis, and a negative direct Coombs test. He also had marked cholestatic jaundice with total bilirubin 22 mg/dL and direct bilirubin 17 mg/dL. Liver enzymes were elevated, and the lipid panel showed extreme hyperlipidemia with total cholesterol 931 mg/dL, triglycerides 401 mg/dL, and HDL 4 mg/dL. Viral hepatitis and other alternative causes of liver injury were ruled out.<br /><br />The diagnosis was Zieve syndrome, a rare and often under-recognized complication of heavy alcohol use characterized by the triad of Coombs-negative hemolytic anemia, cholestatic jaundice, and hyperlipidemia. The report emphasizes that Zieve syndrome can be mistaken for alcoholic hepatitis, which is important because misdiagnosis may lead to unnecessary and potentially harmful glucocorticoid treatment. Although the exact pathophysiology is unclear, the condition is believed to be reversible with alcohol cessation and supportive care.<br /><br />The patient was managed conservatively with IV fluids, electrolyte replacement, two units of packed red blood cells, alcohol withdrawal treatment with phenobarbital and CIWA monitoring, and counseling for abstinence. His bilirubin, lipid abnormalities, and liver tests improved by discharge. The case highlights the importance of recognizing Zieve syndrome early to avoid inappropriate treatment and to ensure recovery with supportive management.

Asset Subtitle

Lukas Veltmaat

Meta Tag

Author List Folasade Arinze, Ijeoma v. Ikedum, Lan Huynh, Lukas Veltmaat, Prasad Rao MD

Category Clinical Vignettes

Concept Zieve Syndrome

Concept Chronic Alcohol Use

Concept Hemolytic Anemia

Concept Abstinence

Concept Hyperlipidemia

Distinguished Non-Finalist

Presenter Organization Medical College of Georgia

Presenting Author Lukas Veltmaat

Track Adult

Keywords

Zieve syndrome

alcohol use disorder

Coombs-negative hemolytic anemia

cholestatic jaundice

hyperlipidemia

hepatomegaly

hepatic steatosis

alcoholic hepatitis

supportive care

glucocorticoid misdiagnosis

Zieve Syndrome

Chronic Alcohol Use

Hemolytic Anemia

Abstinence

Hyperlipidemia