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Zalavadiya R, Bhatt JH, Nagori I, Kagathara N, Neupane S. An unusual case of Zieve's syndrome in a 36-year-old male with latent autoimmune diabetes of adult and disseminated intravascular coagulation. Clin Case Rep 2024; 12:e8445. [PMID: 38292231 PMCID: PMC10823546 DOI: 10.1002/ccr3.8445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Zieve's syndrome, associated with chronic alcoholism, manifests as hemolytic anemia, transient hyperlipidemia, and cholestatic jaundice. Key symptoms comprise nausea, abdominal pain, and jaundice. Diagnosis relies on recognizing the triad in those with an alcohol use history. Supportive management includes blood transfusions and alcohol cessation. The exact pathophysiology remains uncertain, with hypotheses ranging from alcohol-induced liver damage to autoimmune processes. The report emphasizes diagnostic complexities, particularly when concurrent with autoimmune disorders such as latent autoimmune diabetes of adults or complicated by disseminated intravascular coagulation (DIC). A 36-year-old male with latent autoimmune diabetes of adults and an 18-year history of chronic alcoholism presented with yellowish skin discoloration, abdominal pain, and distension. Physical examination revealed signs of anemia, jaundice, pedal edema, hepatomegaly, splenomegaly, and abdominal tenderness. Over eight admissions, multiple tests revealed severe anemia, thrombocytopenia, elevated bilirubin, and positive autoantibodies. Treatment for suspected autoimmune hepatitis showed no improvement. Subsequent examinations indicated DIC, altered liver function, and cirrhosis progression. A confirmed diagnosis of Zieve's syndrome was made. Upper gastrointestinal endoscopy was done to check for esophageal varices which were banded. The patient was subsequently managed on supportive treatment with multiple blood transfusions and abstinence from alcohol. Prompt recognition of Zieve's syndrome is crucial to avoid unnecessary interventions. Alcohol cessation is the keystone of treatment, emphasizing the need to raise awareness among practitioners. This case points toward the importance of comprehensive evaluation, serial investigations, and multidisciplinary collaboration for accurate diagnosis and management. Further research is needed to enhance understanding and optimize therapeutic strategies.
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Affiliation(s)
- Rushit Zalavadiya
- Department of Internal MedicineGMERS Medical College GotriVadodaraIndia
| | - Jugal Hiren Bhatt
- Department of Internal MedicineGMERS Medical College GotriVadodaraIndia
| | - Irfan Nagori
- Department of Internal MedicineGMERS Medical College GotriVadodaraIndia
| | - Nency Kagathara
- Department of Internal MedicineZydus Medical College and HospitalDahodIndia
| | - Srijana Neupane
- Chormara Public Health CenterMadhyabindu MunicipalityNawalpurNepal
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2
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Vedire A, Imburgio S, Sanekommu H, Patel R, Johnson H, Taj S, Hossain M. Unique Variant of Zieve Syndrome With a Normal Reticulocyte Count. J Med Cases 2023; 14:185-190. [PMID: 37435106 PMCID: PMC10332873 DOI: 10.14740/jmc4077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/21/2023] [Indexed: 07/13/2023] Open
Abstract
Zieve syndrome is a rare diagnosis seen in patients with chronic alcohol use which consists of a distinct clinical triad of hyperlipidemia, hemolytic anemia, and jaundice. Patients typically have an elevated reticulocyte count due to the hemolytic nature of the anemia. We present the case of a 44-year-old female who was discovered to have an unusual variant of Zieve syndrome with a normal reticulocyte count, which was believed to be due to suppression of bone marrow from excessive alcohol consumption. She was treated with steroids and complete alcohol cessation, with remarkable improvement on subsequent follow-up. An exhaustive literature review of 31 documented cases of Zieve syndrome was conducted to better understand the clinical presentation and overall prognosis of these patients. This case report and literature review aimed to improve patient outcomes through increased recognition of this underrecognized syndrome.
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Affiliation(s)
- Apurva Vedire
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | - Steven Imburgio
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | | | - Rushi Patel
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | - Haley Johnson
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | - Sobaan Taj
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | - Mohammad Hossain
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
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3
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Nieto LM, Martinez JP, Narvaez S, Attar C, Lall T. A Case of Zieve's Syndrome With the Development of Delirium Tremens. Cureus 2023; 15:e37225. [PMID: 37159778 PMCID: PMC10163960 DOI: 10.7759/cureus.37225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/11/2023] Open
Abstract
A 50-year-old man presented to the emergency department with dark urine and altered mental status. Upon examination, the patient was found to be jaundiced with normal vitals. Laboratory investigation demonstrated macrocytic anemia and abnormal liver function tests. During his hospitalization, he developed delirium tremens in addition to the discovery of acute hemolytic anemia, hypercholesterolemia, and hypertriglyceridemia. Therefore, he was diagnosed with Zieve's syndrome (ZS), a rarely reported disease characterized by hemolytic anemia, cholestatic jaundice, and transient hyperlipidemia. Physicians encountering acute hemolytic anemia in a patient with concomitant acute liver injury should consider ZS as a differential diagnosis, as prompt recognition of the syndrome can help prevent unnecessary procedures and therapy.
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Affiliation(s)
- Luis M Nieto
- Internal Medicine, Wellstar Cobb Medical Center, Austell, USA
| | - John P Martinez
- Internal Medicine, Wellstar Cobb Medical Center, Austell, USA
| | - Sharon Narvaez
- Escuela de Medicina, Universidad de Guayaquil, Guayaquil, ECU
| | - Cinna Attar
- Hospital Medicine, Wellstar Spalding Medical Center, Griffin, USA
| | - Thomas Lall
- Internal Medicine, Wellstar Cobb Medical Center, Austell, USA
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4
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Novel insights into alcoholic liver disease: Iron overload, iron sensing and hemolysis. J Transl Int Med 2022; 10:92-124. [PMID: 35959455 PMCID: PMC9328032 DOI: 10.2478/jtim-2021-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The liver is the major target organ of continued alcohol consumption at risk and resulting alcoholic liver disease (ALD) is the most common liver disease worldwide. The underlying molecular mechanisms are still poorly understood despite decades of scientific effort limiting our abilities to identify those individuals who are at risk to develop the disease, to develop appropriate screening strategies and, in addition, to develop targeted therapeutic approaches. ALD is predestined for the newly evolving translational medicine, as conventional clinical and health care structures seem to be constrained to fully appreciate this disease. This concept paper aims at summarizing the 15 years translational experience at the Center of Alcohol Research in Heidelberg, namely based on the long-term prospective and detailed characterization of heavy drinkers with mortality data. In addition, novel experimental findings will be presented. A special focus will be the long-known hepatic iron accumulation, the somewhat overlooked role of the hematopoietic system and novel insights into iron sensing and the role of hepcidin. Our preliminary work indicates that enhanced red blood cell (RBC) turnover is critical for survival in ALD patients. RBC turnover is not primarily due to vitamin deficiency but rather to ethanol toxicity directly targeted to erythrocytes but also to the bone marrow stem cell compartment. These novel insights also help to explain long-known aspects of ALD such as mean corpuscular volume of erythrocytes (MCV) and elevated aspartate transaminase (GOT/AST) levels. This work also aims at identifying future projects, naming unresolved observations, and presenting novel hypothetical concepts still requiring future validation.
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Haider AA, Salabei JK, Hashmi M, Ismail Z, Zheng M, Iyer UG. Zieve Syndrome in a Patient With Hepatitis C. Cureus 2022; 14:e25412. [PMID: 35663662 PMCID: PMC9154049 DOI: 10.7759/cureus.25412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/18/2022] Open
Abstract
Zieve syndrome is a very rare syndrome that presents as a triad of hemolytic anemia, jaundice, and transient hyperlipidemia in patients with alcoholic liver disease. Herein, we present a case of a 30-year-old female with alcoholic liver disease and chronic hepatitis C. She presented with altered mental status and profound jaundice and was subsequently found to have acute hemolytic anemia due to Zieve syndrome. All other causes of hemolytic anemia were ruled out. She abstained from alcohol and received blood transfusions as needed, leading to the improvement of her anemia. This case highlights the need for more medical education about Zieve syndrome as the under-recognition of the disease can lead to unnecessary treatments. We review the existing literature to explain the epidemiology, pathogenesis, diagnosis, and treatment of Zieve syndrome. This case represents a rare presentation of Zieve syndrome in a patient with hepatitis C, and we have hypothesized a possible role of chronic hepatitis C infection in its pathophysiology.
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Manrai M, Dawra S, Kapoor R, Srivastava S, Singh A. Anemia in cirrhosis: An underestimated entity. World J Clin Cases 2022; 10:777-789. [PMID: 35127894 PMCID: PMC8790443 DOI: 10.12998/wjcc.v10.i3.777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/18/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
Anemia in a patient with cirrhosis is a clinically pertinent but often overlooked clinical entity. Relevant guidelines highlight the algorithmic approach of managing a patient of cirrhosis presenting with acute variceal hemorrhage but day-to-day management in hospital and out-patient raises multiple dilemmas: Whether anemia is a disease complication or a part of the disease spectrum? Should iron, folic acid, and vitamin B complex supplementation and nutritional advice, suffice in those who can perform tasks of daily living but have persistently low hemoglobin. How does one investigate and manage anemia due to multifactorial etiologies in the same patient: Acute or chronic blood loss because of portal hypertension and bone marrow aplasia secondary to hepatitis B or C viremia? To add to the clinician’s woes the prevalence of anemia increases with increasing disease severity. We thus aim to critically analyze the various pathophysiological mechanisms complicating anemia in a patient with cirrhosis with an emphasis on the diagnostic flowchart in such patients and proposed management protocols thereafter.
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Affiliation(s)
- Manish Manrai
- Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India
| | - Saurabh Dawra
- Department of Medicine and Gastroenterology, Command Hospital, Pune 411040, India
| | - Rajan Kapoor
- Department of Medicine, Command Hospital, Kolkata 70027, India
| | - Sharad Srivastava
- Department of Medicine and Gastroenterology, Command Hospital, Pune 411040, India
| | - Anupam Singh
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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7
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Reyes JVM, Ahmad S, Majeed H, Kandoth E, Lieber JJ. Zieve Syndrome: A Clinical Triad, or Perchance a Quartet? J Investig Med High Impact Case Rep 2022; 10:23247096221121393. [PMID: 36086824 PMCID: PMC9465572 DOI: 10.1177/23247096221121393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Zieve syndrome presents with a triad of hemolytic anemia, unexplained jaundice,
and hyperlipidemia secondary to alcohol use/alcohol-induced liver injury,
highlighting hemolytic anemia as the hallmark feature. Zieve syndrome is more
common than originally perceived as its incidence is estimated to be 1 in 1600
admissions, but its mechanism is still poorly understood. This is a case of a
29-year-old man who developed Zieve syndrome shortly after admission for
pancreatitis secondary to alcohol use disorder. Early diagnosis is important to
reduce unnecessary tests and interventions. Further studies should be considered
to evaluate the association between Zieve syndrome and pancreatitis.
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Affiliation(s)
- Jonathan Vincent M. Reyes
- Department of Internal Medicine, Icahn
School of Medicine at Mount Sinai Hospital, Elmhurst Hospital Center, New York, NY,
USA
- Jonathan Vincent M. Reyes, MD, Department
of Internal Medicine, Icahn School of Medicine at Mount Sinai Hospital, Elmhurst
Hospital Center, 79-01 Broadway, New York, NY 11373, USA.
| | - Saad Ahmad
- Department of Internal Medicine, Icahn
School of Medicine at Mount Sinai Hospital, Elmhurst Hospital Center, New York, NY,
USA
| | - Hafsa Majeed
- Department of Internal Medicine, Icahn
School of Medicine at Mount Sinai Hospital, Elmhurst Hospital Center, New York, NY,
USA
| | - Eugenio Kandoth
- Department of Internal Medicine, Icahn
School of Medicine at Mount Sinai Hospital, Elmhurst Hospital Center, New York, NY,
USA
| | - Joseph J. Lieber
- Department of Internal Medicine, Icahn
School of Medicine at Mount Sinai Hospital, Elmhurst Hospital Center, New York, NY,
USA
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Mathur K, Vilar-Gomez E, Connelly MA, He H, Sanyal AJ, Chalasani N, Jiang ZG. Circulating high density lipoprotein distinguishes alcoholic hepatitis from heavy drinkers and predicts 90-day outcome: lipoproteins in alcoholic hepatitis. J Clin Lipidol 2021; 15:805-813. [PMID: 34756674 PMCID: PMC8688310 DOI: 10.1016/j.jacl.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alcohol-associated liver disease (ALD) and alcoholic hepatitis (AH) significantly impact the liver, an organ central to the lipid and lipoprotein metabolism. OBJECTIVE To define changes in the lipid and lipoprotein profiles in subjects with alcoholic hepatitis (AH) versus heavy drinkers with normal liver function and to determine the association of the AH-mediated lipoprotein phenotype with AH severity and outcomes. METHODS AH cases (n=196) and a heavy drinker control group (n=169) were identified in a multicenter, prospective cohort. The relationships between lipid panels and lipoprotein profiles among AH and heavy drinkers were interrogated using three common measurements: the conventional lipid panel, extended lipid panel by NMR, and NMR-based direct lipoprotein profiling. Predictive values for AH severity and mortality were determined using Harrell's C-Index. RESULTS Lipid and lipoprotein profiles were significantly different in AH compared to heavy drinkers. Among them, high density lipoprotein (HDL) particle concentration exhibited the most significant reduction in AH compared to heavy drinkers (5.3 ± 3.4 vs 22.3 ± 5.4 μmol/L, p < 0.001). Within AH patients, HDL particle concentration was inversely associated with Maddrey's Discriminant Function (DF) (p < 0.001), and independently associated with mortality at both 90 and 365 days even after adjustment for DF (p = 0.02, p = 0.05 respectively). HDL particle concentration less than 3.5 μmol/L and total cholesterol ≤ 96 mg/dL identified AH patients with higher 90-day mortality. CONCLUSION Lipid and lipoprotein profiles are profoundly altered in AH and can help in prognosticating disease severity and mortality.
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Affiliation(s)
- Karan Mathur
- Division of Gastroenterology & Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eduardo Vilar-Gomez
- Division of Gastroenterology & Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, NC, USA
| | - Hanchang He
- Divison of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arun J Sanyal
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia
| | - Naga Chalasani
- Division of Gastroenterology & Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Z Gordon Jiang
- Divison of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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9
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Watson C, Hassan M, Breeland G. Multifactorial jaundice and pigmented choledocholithiasis secondary to warm autoimmune hemolytic anemia and alcoholic cirrhosis. Proc AMIA Symp 2021; 35:229-231. [DOI: 10.1080/08998280.2021.1995107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Colten Watson
- Texas A&M Medical School Dallas Campus, Dallas, Texas
| | - Mazen Hassan
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Grant Breeland
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
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10
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Underrecognized Zieve's syndrome, A case report. Ann Med Surg (Lond) 2021; 66:102464. [PMID: 34158930 PMCID: PMC8203730 DOI: 10.1016/j.amsu.2021.102464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 10/25/2022] Open
Abstract
Zieve's syndrome (ZS) is a triad of hemolytic anemia, cholestatic jaundice and hyperlipidemia that presents in the setting of alcohol abuse and liver disease. ZS is not well known and remains underdiagnosed. We present a case of ZS in a 38-year-old female with a history of chronic alcohol abuse and pancreatitis to raise awareness of ZS. It is important for ZS to be recognized promptly to avoid unnecessary and possibly harmful interventions.
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Gaur K, Puri V, Agarwal K, Suman S, Dhamija RK. Chronic Liver Disease Presenting as Immune Hemolytic Anemia: The Challenges of Diagnosis in the Critically Ill in a Resource-Limited Health Care Setting. Cureus 2021; 13:e14880. [PMID: 34104606 PMCID: PMC8179951 DOI: 10.7759/cureus.14880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Immune hemolytic anemia is very rarely associated with chronic liver disease. Diagnosis is often complicated in critically ill patients, where an etiological diagnosis can be elusive, especially in routine health care settings. A 48-year-old man presented with jaundice for three months. Ultrasonography showed features of chronic liver disease. Fibroscan showed increased parenchymal stiffness suggesting cirrhosis. Investigations revealed immune hemolytic anemia and thrombocytopenia. A percutaneous liver biopsy was not performed due to worsening thrombocytopenia. Isolated protein C deficiency and portal vein thrombosis were noted in subsequent testing. The patient eventually succumbed to illness. Coagulopathy such as protein C and D-dimer elevation discovered in subsequent rounds of testing may be misleading in rapidly deteriorating patients, emphasizing the need for timely coagulation workup and imaging. Despite comprehensive testing, lack of liver biopsy, as seen herein, may hamper clinical management. Training residents in the skill of transjugular liver biopsy is necessary to manage critical patients at secondary health care facilities.
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Affiliation(s)
- Kavita Gaur
- Department of Pathology, Lady Hardinge Medical College, Delhi, IND
| | - Vandana Puri
- Department of Pathology, Lady Hardinge Medical College, Delhi, IND
| | - Kiran Agarwal
- Department of Pathology, Lady Hardinge Medical College, Delhi, IND
| | - Santosh Suman
- Department of Pathology, Lady Hardinge Medical College, Delhi, IND
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12
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Tariq T, Karabon P, Irfan FB, Sieloff EM, Patterson R, Desai AP. National Trends and Outcomes of Nonautoimmune Hemolytic Anemia in Alcoholic Liver Disease: Analysis of the Nationwide Inpatient Sample. J Clin Gastroenterol 2021; 55:258-262. [PMID: 32740099 DOI: 10.1097/mcg.0000000000001383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/01/2020] [Indexed: 12/12/2022]
Abstract
GOAL The aim of this study was to determine the burden of nonautoimmune hemolytic anemia (NAHA) in hospitalized patients with coexisting alcoholic liver disease (ALD), identify risk factors for NAHA in ALD and describe the hospitalization outcomes. BACKGROUND ALD can result in structural and metabolic alterations in the red-blood cell membrane leading to premature destruction of erythrocytes and hemolytic anemia of varying severity. STUDY Hospitalized ALD patients with concomitant NAHA were identified in the Nationwide Inpatient Sample database using International Classification of Diseases-9 codes from 2009 to 2014. The primary outcome was to determine the nationwide prevalence and risk factors of NAHA in patients hospitalized with ALD. RESULTS The prevalence of NAHA was 0.17% (n=3585) among all ALD patients (n=2,125,311) that were hospitalized. Multivariate analysis indicated higher odds of NAHA in ALD patients in the following groups: female gender [adjusted odds ratio (AOR) AOR 1.80, P<0.0001]; highest quartile of median household income (AOR 1.88, P<0.0001); increasing Charlson-Deyo Comorbidity Index (3 to 4 vs. 0, AOR 2.16, P=0.0042) and cirrhosis (AOR 2.74, P<0.0001). Discharges of ALD with anemia had a significantly longer average length of stay (8.8 vs. 6.0 d, P<0.0001), increased hospital charges ($38,961 vs. $25,244, P<0.0001) and higher mortality (9.0% vs. 5.6%, P<0.0001) when compared with ALD with no anemia. CONCLUSION NAHA in patients with ALD is an important prognostic marker, predicting a longer, costlier hospitalization and increased inpatient mortality in ALD.
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Affiliation(s)
| | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Detroit
| | - Furqan B Irfan
- College of Osteopathic Medicine, Michigan State University, East Lansing
| | - Eric M Sieloff
- Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
| | - Rachel Patterson
- Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Archita P Desai
- Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
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13
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Achufusi TG, Sandhu J, Chahal J, Shepherd Z, Mirchia K. Zieve syndrome in acute alcoholic hepatitis. Proc (Bayl Univ Med Cent) 2020; 33:380-381. [PMID: 32675955 DOI: 10.1080/08998280.2020.1735238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022] Open
Abstract
A 31-year-old woman presented with acute alcoholic hepatitis, jaundice, anemia, and hypertriglyceridemia following ethylene glycol poisoning. She had no previous history of anemia or gastrointestinal bleeding. Laboratory findings were consistent with acute hemolytic anemia. She was diagnosed with Zieve syndrome and was managed with supportive measures. Zieve syndrome is a rare occurrence with only a handful of published case reports. Although rare, the diagnosis should be on the differential in this subgroup of patients to avoid unnecessary and invasive diagnostic interventions.
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Affiliation(s)
- Ted George Achufusi
- Department of Internal Medicine, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Jasmine Sandhu
- Department of Internal Medicine, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Japjot Chahal
- Department of Internal Medicine, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Zachary Shepherd
- Department of Internal Medicine, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Kanish Mirchia
- Department of Pathology, State University of New York Upstate Medical UniversitySyracuseNew York
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14
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Abstract
Zieve's syndrome (ZS) is a rare disease characterized by a triad of hemolytic anemia, cholestatic jaundice, and transient hyperlipidemia seen in patients with alcoholic steatohepatitis. We report a case of ZS with severe hypertriglyceridemia. Among the reported cases of ZS in English literature, we believe this is the first case of the syndrome presenting with severe hypertriglyceridemia requiring plasmapheresis.
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Abughanimeh O, Kaur A, Numan L, Bahaj W, Madhusudhana S. Zieve's Syndrome: An Under-reported Cause of Anemia in Alcoholics. Cureus 2019; 11:e4121. [PMID: 31037235 PMCID: PMC6478496 DOI: 10.7759/cureus.4121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Anemia is a common finding in alcoholics. It is often multifactorial and caused by a combination of liver dysfunction, ineffective erythropoiesis, and poor nutrition. Zieve’s syndrome (ZS) is a clinical syndrome that presents with a triad of jaundice, hemolytic anemia, and hyperlipidemia secondary to alcohol use. Herein, we present a case of a 58-year-old male with a history of liver cirrhosis who presented after a fall due to binge drinking and was found to have severe anemia. Workup was consistent with hemolytic anemia with no source of active bleeding. The patient was managed with supportive treatment and blood transfusions which improved his anemia. However, given his advanced liver disease, he developed encephalopathy and subsequently severe aspiration pneumonia. He died 18 days after admission.
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Affiliation(s)
- Omar Abughanimeh
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Anahat Kaur
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Laith Numan
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Waled Bahaj
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Sheshadri Madhusudhana
- Hematology and Oncology, University of Missouri-Kansas City School of Medicine, Kansas City, USA
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