P1058 - Alcoholic Cirrhosis Leading to Zieve's Syndrome

Allison Derise, MD¹, Sidney M. Mejia, MD, MPH^2
1Louisiana State University Health Sciences Center, New Orleans, LA; ²LSU, New Orleans, LA

Introduction: Zieve’s Syndrome is a diagnosis that was initially described in 1957 and is defined by the triad of jaundice, hemolytic anemia, and hyperlipidemia in a patient with liver injury secondary to alcohol use. Because of the various effects the liver has on the hematopoietic system, Zieve’s Syndrome is under-recognized as an acute form of hemolytic anemia. Zieve’s Syndrome is essential to recognize in patients because it can prevent unnecessary and costly work ups for etiologies of anemia in patients and is more common than previously believed.




In this case report, we discuss one patient with two separate hospital presentations with laboratory values consistent with Zieve’s Syndrome.

Case Description/Methods: This patient is a 33-year-old female with a past medical history notable for hepatitis secondary to alcohol use disorder who presented twice to the hospital 2 months apart. The first presentation was for 3 days of worsening abdominal pain, distention, jaundice, low grade fevers, nausea, and vomiting. At the second presentation 2 months later, she presented for increased bruising with associated decreased appetite, fatigue, and jaundice of skin and eyes. The physical exam during the second hospitalization was notable for hepatomegaly, significant jaundice, and spider angiomas. Retrospective review of labs during the 12/2022 admission were notable for low hemoglobin; elevated total, direct, and indirect bilirubin levels; and elevated cholesterol and triglyceride levels. During the 02/2023 admission, hemoglobin, bilirubin levels, cholesterol, HDL, and triglyceride levels all worsened and hemolytic labs were remarkable for low haptoglobin and low fibrinogen (Table 1). The patient was treated with supportive measures and discharged to an alcohol detoxification program.

Discussion: Zieve’s Syndrome is under-reported and under-recognized cause of acute hemolytic anemia in patients with alcoholic cirrhosis. In cases of delayed diagnosis, investigation of unexplained hyperbilirubinemia has been known to result in unnecessary biliary interventions such as ERCP. Following cessation of alcohol consumption, patients can expect to improve within 4 to 6 weeks, with hyperlipidemia improving as early as 10 days following cessation. This case is an example of a possible misdiagnosis during initial hospitalization, and our hope is for increased recognition to lead to a reduction in delayed diagnoses, cost-effective medicine and reduction of the risks associated with avoidable procedures and treatments.



Disclosures:


Allison Derise, MD¹, Sidney M. Mejia, MD, MPH². P1058 - Alcoholic Cirrhosis Leading to Zieve's Syndrome, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.