J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://www.journalmc.org

Case Report

Volume 14, Number 6, June 2023, pages 185-190

Unique Variant of Zieve Syndrome With a Normal Reticulocyte Count

**Table 1.** Initial Laboratory Values on Admission
Labs	Value (unit)	Reference range
White blood cell	4.4 × 10³/µL	4.5 - 11.0 × 10³/µL
Red blood cell	2.85 × 10⁶/µL	4.10 - 5.10 × 10⁶/µL
Hemoglobin	10.2 g/dL	12 - 16 g/dL
Platelet count	110 × 10³/µL	140 - 450 × 10³/µL
Total bilirubin	16.9 mg/dL	0.2 - 1.3 mg/dL
Direct bilirubin	12.8 mg/dL	0.0 - 0.3 mg/dL
Alkaline phosphatase	287 U/L	46 - 116 U/L
Aspartate aminotransferase	333 U/L	0 - 34 U/L
Alanine transaminase	25 U/L	10 - 49 U/L
Reticulocyte count	2.06%	0.40-2.50%
Haptoglobin	1 mg/dL	40 - 280 mg/dL
Lactate dehydrogenase	326 U/L	120 - 246 U/L
Ferritin	2,718.3 ng/mL	7.3 - 270.7 ng/mL
Iron	85 µg/dL	50 - 170 µg/dL
Total iron binding capacity	157 µg/dL	250 - 425 µg/dL
Transferrin	68 mg/dL	250 - 380 mg/dL
Thyroid-stimulating hormone	39.660 µIU/mL	0.550 - 4.780 µIU/mL
Gamma glutamyl transpeptidase	461 U/L	< 38 U/L
Immunoglobulin A	560 mg/dL	40 - 350 mg/dL
Ammonia	76 µmol/L	11 - 32 µmol/L
Cholesterol	232 mg/dL	< 200 mg/dL
Triglycerides	249 mg/dL	0 - 150 mg/dL
High-density lipoprotein	< 20 mg/dL	40 - 60 mg/dL
Low-density lipoprotein	134 mg/dL	< 100 mg/dL

Table 1. Initial Laboratory Values on Admission

Labs

Value (unit)

Reference range

White blood cell

4.4 × 10³/µL

4.5 - 11.0 × 10³/µL

Red blood cell

2.85 × 10⁶/µL

4.10 - 5.10 × 10⁶/µL

Hemoglobin

10.2 g/dL

12 - 16 g/dL

Platelet count

110 × 10³/µL

140 - 450 × 10³/µL

Total bilirubin

16.9 mg/dL

0.2 - 1.3 mg/dL

Direct bilirubin

12.8 mg/dL

0.0 - 0.3 mg/dL

Alkaline phosphatase

287 U/L

46 - 116 U/L

Aspartate aminotransferase

333 U/L

0 - 34 U/L

Alanine transaminase

25 U/L

10 - 49 U/L

Reticulocyte count

2.06%

0.40-2.50%

Haptoglobin

1 mg/dL

40 - 280 mg/dL

Lactate dehydrogenase

326 U/L

120 - 246 U/L

Ferritin

2,718.3 ng/mL

7.3 - 270.7 ng/mL

Iron

85 µg/dL

50 - 170 µg/dL

Total iron binding capacity

157 µg/dL

250 - 425 µg/dL

Transferrin

68 mg/dL

250 - 380 mg/dL

Thyroid-stimulating hormone

39.660 µIU/mL

0.550 - 4.780 µIU/mL

Gamma glutamyl transpeptidase

461 U/L

< 38 U/L

Immunoglobulin A

560 mg/dL

40 - 350 mg/dL

Ammonia

76 µmol/L

11 - 32 µmol/L

Cholesterol

232 mg/dL

< 200 mg/dL

Triglycerides

249 mg/dL

0 - 150 mg/dL

High-density lipoprotein

< 20 mg/dL

40 - 60 mg/dL

Low-density lipoprotein

134 mg/dL

< 100 mg/dL

**Table 2.** Follow-Up Hemoglobin Values
Hospital day	Hemoglobin value (reference range 12 - 16 g/dL)
1	10.2 g/dL
2	8.5 g/dL
3	7.9 g/dL

Table 2. Follow-Up Hemoglobin Values

Hospital day

Hemoglobin value (reference range 12 - 16 g/dL)

10.2 g/dL

8.5 g/dL

7.9 g/dL

**Table 3.** Follow-Up Laboratory Values 1 Month Later
Labs	Value	Reference range
Total bilirubin	4.1 mg/dL	0.2 - 1.3 mg/dL
White blood cell	9.8 × 10³/µL	4.5 - 11.0 × 10³/µL
Hemoglobin	12.6 g/dL	12 - 16 g/dL
Platelet count	188 × 10³/µL	140 - 450 × 10³/µL

Table 3. Follow-Up Laboratory Values 1 Month Later

Labs

Value

Reference range

Total bilirubin

4.1 mg/dL

0.2 - 1.3 mg/dL

White blood cell

9.8 × 10³/µL

4.5 - 11.0 × 10³/µL

Hemoglobin

12.6 g/dL

12 - 16 g/dL

Platelet count

188 × 10³/µL

140 - 450 × 10³/µL

**Table 4.** Literature Review Findings
Study	Age (years old)	Sex	Abdominal pain present?	Initial triglyceride levels (mg/dL)	Initial hemoglobin level (g/dL)	Initial reticulocyte count (%)	Initial total bilirubin level (mg/dL)	Initial direct bilirubin level (mg/dL)	Alive at discharge?
N/A: not available.
Gitlin, 1969 [23]	48	Male	Yes	441	12.5	5.0	10.0	9.0	Yes
Benraad et al, 1977 [24]	28	Male	Yes	137.4	8.7	3.7	1.2	0.2	Yes
	31	Male	Yes	130.0	7.9	5.8	1.6	0.5	Yes
	50	Male	Yes	3.85	8.0	5.1	1.8	1.0	Yes
	33	Female	Yes	3.03	8.1	13.5	0.9	0.4	Yes
	56	Female	No	3.27	8.7	14.0	25.2	20.4	Yes
	49	Female	Yes	327	6.3	21.0	5.0	3.0	Yes
	41	Male	Yes	3.4	8.2	12.2	2.3	1.1	Yes
	41	Male	No	4.14	7.3	13.2	3.2	1.8	Yes
	63	Male	No	N/A	7.4	5.55	13.5	8.8	Yes
	65	Male	No	4.71	8.0	20.0	13.1	10.4	Yes
	43	Male	No	34.7	6.8	5.4	2.1	1.3	Yes
	30	Female	No	4.05	6.8	8.1	3.6	2.2	Yes
	31	Female	No	2.7	6.6	8.3	2.2	1.1	Yes
	32	Female	Yes	4.0	5.8	12.6	1.7	0.7	Yes
	29	Male	Yes	10.7	7.7	7.6	1.8	0.9	Yes
Pickens et al, 1979 [25]	66	Female	No	168.3	5.7	11.5	16.08	N/A	No
Martin et al, 1996 [26]	59	Female	Yes	1,700.5	8.8	5.8	2.4	N/A	Yes
Pilcher et al, 1996 [27]	39	Male	Yes	11,425.5	13.2	N/A	1.0	N/A	Yes
Piccini et al, 2003 [3]	47	Female	Yes	N/A	7.7	3.5	4.2	2.3	Yes
Hashmi et al, 2014 [16]	30	Female	No	578.0	10.6	8.1	38.0	26.0	Yes
Shukla et al, 2015 [11]	45	Male	No	N/A	6.5	N/A	16.0	6.3	Yes
Senatore et al, 2016 [19]	32	Male	Yes	464	8.5	N/A	20.0	13.0	Yes
Liu et al, 2017 [22]	30	Female	No	311.9	7.7	6.1	21.3	13.5	Yes
Gremida et al, 2018 [1]	46	Female	Yes	208.0	7.1	11.0	12.0	2.0	Yes
Abughanimeh et al, 2019 [28]	58	Male	Yes	N/A	5.5	16.2	4.0	N/A	No
Choudhry et al, 2019 [8]	46	Male	Yes	4,425.0	12.6	6.2	2.9	2.0	Yes
Achufusi et al, 2020 [29]	31	Female	No	8,890.0	8.1	N/A	19.1	8.7	Yes
Gosal et al, 2021 [30]	38	Female	Yes	172.0	6.9	5.7	11.2	2.0	Yes
Sams et al, 2022 [17]	30	Male	Yes	5,679.0	12.5	N/A	2.1	N/A	Yes
Sivanandam et al, 2022 [31]	42	Male	No	215.0	8.4	N/A	10.9	4.4	Yes

Table 4. Literature Review Findings

Study

Age (years old)

Sex

Abdominal pain present?

Initial triglyceride levels (mg/dL)

Initial hemoglobin level (g/dL)

Initial reticulocyte count (%)

Initial total bilirubin level (mg/dL)

Initial direct bilirubin level (mg/dL)

Alive at discharge?

N/A: not available.

Gitlin, 1969 [23]

Male

Yes

441

12.5

5.0

10.0

9.0

Yes

Benraad et al, 1977 [24]

Male

Yes

137.4

8.7

3.7

1.2

0.2

Yes

Male

Yes

130.0

7.9

5.8

1.6

0.5

Yes

Male

Yes

3.85

8.0

5.1

1.8

1.0

Yes

Female

Yes

3.03

8.1

13.5

0.9

0.4

Yes

Female

3.27

8.7

14.0

25.2

20.4

Yes

Female

Yes

327

6.3

21.0

5.0

3.0

Yes

Male

Yes

3.4

8.2

12.2

2.3

1.1

Yes

Male

4.14

7.3

13.2

3.2

1.8

Yes

Male

N/A

7.4

5.55

13.5

8.8

Yes

Male

4.71

8.0

20.0

13.1

10.4

Yes

Male

34.7

6.8

5.4

2.1

1.3

Yes

Female

4.05

6.8

8.1

3.6

2.2

Yes

Female

2.7

6.6

8.3

2.2

1.1

Yes

Female

Yes

4.0

5.8

12.6

1.7

0.7

Yes

Male

Yes

10.7

7.7

7.6

1.8

0.9

Yes

Pickens et al, 1979 [25]

Female

168.3

5.7

11.5

16.08

N/A

Martin et al, 1996 [26]

Female

Yes

1,700.5

8.8

5.8

2.4

N/A

Yes

Pilcher et al, 1996 [27]

Male

Yes

11,425.5

13.2

N/A

1.0

N/A

Yes

Piccini et al, 2003 [3]

Female

Yes

N/A

7.7

3.5

4.2

2.3

Yes

Hashmi et al, 2014 [16]

Female

578.0

10.6

8.1

38.0

26.0

Yes

Shukla et al, 2015 [11]

Male

N/A

6.5

N/A

16.0

6.3

Yes

Senatore et al, 2016 [19]

Male

Yes

464

8.5

N/A

20.0

13.0

Yes

Liu et al, 2017 [22]

Female

311.9

7.7

6.1

21.3

13.5

Yes

Gremida et al, 2018 [1]

Female

Yes

208.0

7.1

11.0

12.0

2.0

Yes

Abughanimeh et al, 2019 [28]

Male

Yes

N/A

5.5

16.2

4.0

N/A

Choudhry et al, 2019 [8]

Male

Yes

4,425.0

12.6

6.2

2.9

2.0

Yes

Achufusi et al, 2020 [29]

Female

8,890.0

8.1

N/A

19.1

8.7

Yes

Gosal et al, 2021 [30]

Female

Yes

172.0

6.9

5.7

11.2

2.0

Yes

Sams et al, 2022 [17]

Male

Yes

5,679.0

12.5

N/A

2.1

N/A

Yes

Sivanandam et al, 2022 [31]

Male

215.0

8.4

N/A

10.9

4.4

Yes

**Table 5.** Summary of Table 4 Findings
	Age	Sex	Abdominal pain present?	Initial triglyceride levels	Initial hemoglobin level	Initial reticulocyte count	Initial total bilirubin level	Initial direct bilirubin level	Alive at discharge?
Average	42.2 years old	54.8% male	58.1%	822.5 mg/dL	8.2 g/dL	9.4%	8.7 mg/dL	5.5 mg/dL	93.5%

Table 5. Summary of Table 4 Findings

Age

Sex

Abdominal pain present?

Initial triglyceride levels

Initial hemoglobin level

Initial reticulocyte count

Initial total bilirubin level

Initial direct bilirubin level

Alive at discharge?

Average

42.2 years old

54.8% male

58.1%

822.5 mg/dL

8.2 g/dL

9.4%

8.7 mg/dL

5.5 mg/dL

93.5%