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

## TL;DR

This case report describes a rare liver-related condition called Zieve syndrome in a young woman with unusual symptoms and reviews atypical presentations of the disease.

## Contribution

The paper presents an atypical case of Zieve syndrome and reviews its uncommon clinical manifestations.

## Key findings

- A 33-year-old female presented with abdominal discomfort, melanotic stools, and hematemesis, leading to a Zieve syndrome diagnosis.
- The case highlights the variability in clinical presentation of Zieve syndrome beyond the typical symptoms.
- The patient responded to standard treatment approaches including alcohol abstinence and supportive care.

## Abstract

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.