P3931 - Zieve’s Syndrome: An Under-Recognized Etiology of Anemia in Alcoholics

Muhammad Hussain, MD¹, Fnu Marium, MD², Rewanth Katamreddy, MD³, Anthony Armanious, ⁴, Wajeeha Aiman, MD⁵, Gunwant Guron, MD⁵, Yatinder Bains, MD^5
1Saint Michael's Medical Center, New York Medical College, Newark, NJ; ²Jinnah Sindh Medical University, Harrison, NJ; ³Saint Michael’s Medical Center, Newark, NJ; ⁴Seton Hall Preparatory School, Newark, NJ; ⁵Saint Michael's Medical Center, Newark, NJ

Introduction: Anemia in alcoholics is often multifactorial. Zieve’s syndrome (ZS) is a triad of jaundice, hemolytic anemia, and hyperlipidemia that develops secondary to alcohol use disorder (AUD). Anemia is very common in alcoholics, and it is often multifactorial. Here we are reporting a case of ZS causing persistent hemolytic anemia and hyperbilirubinemia in alcoholic patient.

Case Description/Methods: 47 YO F PMH hypertension, fibroids, AUD was sent to the ED for evaluation of low Hb 6.4 (MCV 90). Last menstrual period was normal one month ago. Denied any melena or hematochezia. Recent EGD showed grade D esophagitis and colonoscopy done 1 month ago showed internal hemorrhoids. She used to drink 3 to 4 beers daily since age of 18 and quit 2 weeks ago. She was admitted 3 times in last 8 months for anemia. Afebrile and hemodynamically stable with no evidence of overt bleeding. Anemia workup done during this and previous admission consistent with nonimmune hemolytic anemia. Labs showed haptoglobin < 31 mg/dl, LDH 440, negative coombs test, total bilirubin 8.6 mg/dl (direct bili 2.2), AST/ALT 43/11 with ALP/GGT WNL, PT/INR 22/1.92, ferritin 862, low TIBC, iron sat 43.1, folic acid/vit B12 WNL, platelets were 108, albumin 2.6. APRI and fib 4 score consistent with advanced fibrosis secondary to AUD. Lipid panel unremarkable except total cholesterol 251. Adam TS13 activity, G6PD (Quant), lupus anticoagulant, autoimmune panel, antimitochondrial antibody, hepatitis panel, HIV were negative. Peripheral blood smear showed anisocytosis with some burr cells. US abdomen showed echogenic liver with hepatofugal venous flow and no biliary dilatation. In view of non-immune hemolytic anemia, jaundice in a patient with alcoholic liver disease with negative above-mentioned workup, diagnosis of Zieve's syndrome was made. She was transfused with 2 units of PRBC during this admission and was counseled regarding importance of alcohol abstinence in treating the anemia due to Zieve's syndrome. She was discharged with outpatient follow-up.

Discussion: Treatment of ZS includes supportive management with blood transfusion and abstinence from alcohol. Even though ZS is rarely reported, it should be suspected in patients with worsening hemolytic anemia with no apparent explanation, especially in alcoholics. Being aware of ZS can limit workup, cost and help avoid using unnecessary drugs that can worsen the condition.


Disclosures:


Muhammad Hussain, MD¹, Fnu Marium, MD², Rewanth Katamreddy, MD³, Anthony Armanious, ⁴, Wajeeha Aiman, MD⁵, Gunwant Guron, MD⁵, Yatinder Bains, MD⁵. P3931 - Zieve’s Syndrome: An Under-Recognized Etiology of Anemia in Alcoholics, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.