Atypical case presentation of Zieve's syndrome

The aim of this case is to make the primary care physician and hospitalist aware of the clinical presentation and treatment protocol for Zieve's syndrome. Zieve's syndrome is relatively rare yet serious and treatable sequela of alcohol abuse. Clinical presentation includes the constellation of symptoms of hemolytic anemia, hyperlipidemia, abdominal pain and jaundice in the context of known alcohol abuse. The exact pathophysiologic mechanism is unknown but, as reviewed in the article, has been postulated to be secondary to alcohol induced hyperlipidemia that in turn predisposes red cell membranes to lysis. The current case demonstrates a variant on the theme of Zieve's syndrome in that the patient's lipid panel was essentially normal suggesting that the exact mechanism of hemolysis is still uncertain. The addition of Zieve's syndrome to the hospitalist differential of an alcoholic patient presenting with hemolysis will allow earlier diagnosis, intervention and better patient outcomes.