Abstract
Anemia is a common finding in alcoholics. It is often multifactorial and caused by a combination of liver dysfunction, ineffective erythropoiesis, and poor nutrition. Zieve’s syndrome (ZS) is a clinical syndrome that presents with a triad of jaundice, hemolytic anemia, and hyperlipidemia secondary to alcohol use. Herein, we present a case of a 58-year-old male with a history of liver cirrhosis who presented after a fall due to binge drinking and was found to have severe anemia. Workup was consistent with hemolytic anemia with no source of active bleeding. The patient was managed with supportive treatment and blood transfusions which improved his anemia. However, given his advanced liver disease, he developed encephalopathy and subsequently severe aspiration pneumonia. He died 18 days after admission.
Highlights
Zieve’s syndrome (ZS) is a triad of jaundice, hemolytic anemia, and hyperlipidemia that develops secondary to alcohol-induced liver injury [1]
ZS is a clinical syndrome that manifests as a triad of jaundice, hemolytic anemia and hyperlipidemia due to alcohol-induced liver injury
It was first described by Dr Zieve in 1958 when he studied 20 patients with hemolytic anemia associated with alcohol abuse [1]
Summary
Zieve’s syndrome (ZS) is a triad of jaundice, hemolytic anemia, and hyperlipidemia that develops secondary to alcohol-induced liver injury [1]. A 58-year-old male with a history of liver cirrhosis secondary to alcohol abuse, presented with right hip pain, abdominal pain, and severe anemia. Liver Doppler ultrasound showed a heterogenous liver with no focal lesions, patent hepatic and portal veins, and no biliary ductal dilatation The patient was diagnosed with atypical ZS and supportive treatment was recommended His hospitalization was complicated by encephalopathy, aspiration pneumonia, and septic shock. Labs/Hospital day Complete blood count Hemoglobin (g/dl) Platelet count (per cmm) Liver function test INR Total bilirubin (mg/dl) AST (U/L) ALT (U/L) Lipid panel LDL (mg/dl) HDL (mg/dl) Total cholesterol Triglycerides (mg/dl) Hemolytic workup Coomb’s test (Direct & indirect) Reticulocyte count Haptoglobin (mg/dl) Lactate dehydrogenase (U/L). INR: International normalized ratio; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; LDL: Low-density lipoprotein; HDL: High-density lipoprotein
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