P1272 - Recognizing Zieve’s Syndrome: Can we Increase the Awareness Among Physicians?

Temitope Tobun, MD¹, Victoria Earl, MD², Cedric Cole, MD¹, Shaila Day, DO^1
1Morehouse School of Medicine, Atlanta, GA; ²Emory University School of Medicine, Atlanta, GA

Introduction: Zieve syndrome (ZS) is defined as a triad of hemolytic anemia, jaundice, and hyperlipidemia resulting from alcohol abuse [1]. Despite numerous cases, it remains under-recognized which may lead to unnecessary diagnostic procedures. We report two cases that almost went undiagnosed.

Case Description/Methods: Our first patient, a 50-year-old female with a history of alcohol use disorder complicated by hepatic cirrhosis, presented to the emergency room (ER) with alcohol intoxication. She was encephalopathic and jaundiced. Laboratory values were significant for an alcohol level of 502, elevated liver enzymes with total bilirubin of 7.1, direct bilirubin of 2.3, hyperlipidemia, anemia with high reticulocyte count, and low haptoglobin < 30. Gastroenterology (GI) was consulted for hyperbilirubinemia management, whereupon the diagnosis of ZS was made.









Our second patient, a 36-year-old male with a history of alcohol use disorder, presented to the ER after blacking out. He was encephalopathic and jaundiced. Laboratory values were significant for alcohol level of 469, elevated liver enzymes with total bilirubin of 23, direct bilirubin of 17.8, anemia with elevated LDH of 602 and high reticulocyte count. Due to concern for acute liver failure GI was consulted. Additional work-up revealed hyperlipidemia. Hence, ZS was suspected.









The diagnosis of ZS in these patients was made based on the history of heavy alcohol use and recognition of the classic clinical triad. These two patients were counseled on alcohol cessation with plans to follow up in GI clinic.

Discussion: The diagnosis of ZS was overlooked in these cases due to a lack of familiarity among physicians. Recognizing this condition is crucial, as it can often be reversed through alcohol cessation. Notably, there has been one reported mortality from this generally reversible condition [2]. Increasing physician awareness is key to early detection and preventing progression.


Disclosures:


Temitope Tobun, MD¹, Victoria Earl, MD², Cedric Cole, MD¹, Shaila Day, DO¹. P1272 - Recognizing Zieve’s Syndrome: Can we Increase the Awareness Among Physicians?, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.