Haemorrhagic Retinopathy Associated with Zieve Syndrome

Zieve syndrome, a scarcely reported case is a triad of jaundice, haemolytic anaemia and hyperlipidaemia that develops secondary to alcohol-induced liver injury. Herein, a case of 23-year-old young male with history of steatohepatitis is reported who presented with diminution of vision in both eyes. On fundoscopy, there were extensive retinal haemorrhages involving fovea. Workup was consistent with haemolytic anaemia with no source of active bleeding. The patient was managed with supportive treatment. No specific ocular treatment was given. However, the vision gradually improved during follow-up. A rare association of zieve syndrome with haemorrhagic retinopathy is described here. Moreover, zieve syndrome has been described in the literature, mostly in non-English language case studies and is still under-recognised and under-reported. Diagnosis should be made quickly to avoid unnecessary invasive diagnostic interventions.

Zieve’s syndrome presenting with coagulopathy, skin and subcutaneous haemorrhage

Zieve syndrome is characterized by hepatic dysfunction, jaundice, hyperlipidaemia, and reversible hemolytic anaemia after alcohol abuse. We report a rare case of this syndrome presenting with coagulopathy and subcutaneous haemorrhage. Laboratory tests showed macrocytic anaemia, hyperbilirubinemia, increased activity of aminotransferases, hyperlipidemia, coagulopathy, signs of haemolysis: reduced concentration of haptoglobin, free hemoglobin. These abnormalities improved during 20 days. Ultrasonography revealed subcutaneous haemorrhagias, liver biopsy was consistent with steatohepatitis. There are a small number of reported cases of Zieve syndrome, and the reason could be the lack of pathognomonic symptoms, rapid decrease of hyperlipidaemic serum levels after alcohol withdrawal, patients denial of drinking. There is no specific treatment, therapy is similar to that for acute alcoholic hepatitis. The Zieve syndrome must be allways considered in the differential diagnosis of uncertain origin liver injury, hemolysis or coagulopathy.