Background: Zieve’s syndrome is an uncommon complication of chronic alcohol abuse, which presents with a constellation of symptoms, particularly hepatic dysfunction, hyperlipidemia and reversible hemolytic anemia.

Objective: This paper presents the first documented case of Zieve’s syndrome in the Philippines.

Case History: We present a rare case of a 46-year-old Filipino male, who manifested with a two-week history of intermittent high grade fever, jaundice, crampy non-radiating epigastric pain, which were later accompanied by tea colored urine and acholic stools. The patient subsequently presented with sudden anemia on his third hospital day with no signs of bleeding or blood loss. Physical examination revealed diffuse jaundice and hepatomegaly with mild epigastric and right upper quadrant tenderness. Laboratory findings showed significant elevation of liver transaminases, bilirubins and triglycerides. Complete blood count (CBC) revealed a drop of hemoglobin from 134 mg/dl to 64 mg/dl. Coomb’s test was negative. Repeat aspartate transaminase (AST) and alanine transaminase (ALT) was decreased.

Conclusion: The patient was diagnosed with Zieve’s syndrome and was given supportive management including adequate hydration and nutritional supplementation with abstinence from alcohol. Improvement in general status with a gradual resolution of jaundice and anemia were observed. Without further intervention, the patient was discharged improved after five days. Out patient follow-up noted further reduction of liver enzymes and triglycerides, and normalization of hemoglobin.

Zieve’s syndrome is an uncommon condition characterized by hemolytic anemia in conjunction with secondary hyperlipidemia in patients suffering from alcohol-related toxic liver damage. This condition must be considered in the differential diagnosis of liver injury with uncertain origin, hemolysis or hemorrhage to prevent unnecessary workups and invasive interventions. Vigilance and high clinical suspicion is important in the diagnosis of the syndrome.

Keywords: Zieve’s syndrome, hepatocellular injury, hypertriglyceridemia, hemolysis, hepatic dysfunction, alcoholism

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