Atypical Presentation of Zieve Syndrome: A Case Report and Literature Review

Zieve syndrome is a rare pathology usually diagnosed in patients with a history of alcohol-related liver disease. It is characterized by a triad of Coombs-negative hemolytic anemia, cholestatic jaundice, and hyperlipidemia. Patients usually present with abdominal pain, nausea, jaundice, and ill-defined symptoms. While Zieve syndrome is associated with alcohol-induced liver injury, its mechanism of action is still poorly understood. Nevertheless, most patients respond well to alcohol abstinence, blood transfusions, and supportive care. Herein, we report the case of a 33-year-old female patient who presented to the ED with complaints of abdominal discomfort, intermittent melanotic stools, and hematemesis. Gastroenterology and Oncology were consulted for further evaluation and management. The patient was subsequently diagnosed with Zieve syndrome. In this report, we review this unique case and discuss different atypical forms of presentation in Zieve syndrome, as highlighted in previous studies.