Zieve Syndrome Beyond Alcohol: A Case and Literature Review Highlighting Autoimmune and Nutritional Contributions to a Rare Hemolytic Triad.

Zieve syndrome is a rare alcohol-related disorder characterized by a triad of Coombs-negative hemolytic anemia, cholestatic jaundice, and transient hyperlipidemia. Its recognition is often delayed due to overlapping features with other hepatic pathologies, particularly alcoholic hepatitis. We present the case of a 35-year-old man with a history of alcohol use disorder, autoimmune hepatitis, and malnutrition who presented with jaundice, severe anemia, and hyperlipidemia. Laboratory evaluation revealed hemolytic anemia and cholestasis, and imaging showed hepatomegaly and hepatic steatosis. A clinical diagnosis of Zieve syndrome was made. Supportive care and alcohol cessation led to rapid clinical and laboratory improvement. This case highlights potential contributing factors beyond alcohol, including autoimmune liver disease and nutritional deficiency. A review of 11 published cases revealed similar patterns, suggesting that hepatic comorbidities may predispose to or exacerbate this syndrome. Clinicians should maintain a high index of suspicion for Zieve syndrome in patients with alcohol use disorder and anemia, particularly when bilirubin elevation and hyperlipidemia coexist. Prompt diagnosis may avoid unnecessary interventions and improve patient outcomes.