Zieve syndrome is a rare diagnosis seen in patients with chronic alcohol use which consists of a distinct clinical triad of hyperlipidemia, hemolytic anemia, and jaundice. Patients typically have an elevated reticulocyte count due to the hemolytic nature of the anemia. We present the case of a 44-year-old female who was discovered to have an unusual variant of Zieve syndrome with a normal reticulocyte count, which was believed to be due to suppression of bone marrow from excessive alcohol consumption. She was treated with steroids and complete alcohol cessation, with remarkable improvement on subsequent follow-up. An exhaustive literature review of 31 documented cases of Zieve syndrome was conducted to better understand the clinical presentation and overall prognosis of these patients. This case report and literature review aimed to improve patient outcomes through increased recognition of this underrecognized syndrome.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is mostly implicated in soft tissue and skin infections. Cases with meningitis caused by CA-MRSA are rare. High index of suspicion should be kept for physicians as bacterial meningitis is a medical emergency and if untreated, has a high mortality rate. Urgent steps need to be taken to determine the cause and implement therapy. Here, we reported a case of a 58-year-old female with MRSA bacteremia and meningitis as confirmed by positive blood cultures and cerebrospinal fluid analysis; successfully managed with vancomycin and rifampin.

Acute cholangitis is a well-known biliary tree pathology most often encountered in patients with gallstone disease. When left untreated, acute cholangitis can lead to severe complications, including death. Therefore, identifying and properly treating acute cholangitis is crucial to avoiding such complications. This paper describes an 84-year-old female patient with acute cholangitis who presented with atypical symptoms of chest pain and cough. The patient was successfully treated with endoscopic retrograde cholangiopancreatography (ERCP), antibiotics, and ursodeoxycholic acid. We focus on this patient's unique presentation to highlight the low incidence of Charcot's triad and Reynold's pentad in elderly patients and to emphasize the importance of formulating a broad differential in patients with non-specific symptoms.

Esophageal cancer is the sixth leading cause of cancer-related death worldwide. Metachronous malignancies refer to multiple independent primary cancers diagnosed at least 6 months apart. The incidence of metachronous esophageal cancers with different histologic subtypes is extremely rare. This case presents an unprecedented occurrence of esophageal adenocarcinoma, followed by metachronous squamous cell carcinoma.

Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is a rare abnormality comprising a series of symptoms that make up a syndrome. It usually happens during pregnancy or right after delivery. We describe a case of a 31-year-old female G4P2A2 (Gravida 4 Para 2 Abortions 2) who presented to the hospital for normal vaginal delivery but immediately postpartum developed HELLP syndrome. Acute fatty liver of pregnancy was a differential that the patient also met the criteria for. Her condition improved after starting her on plasmapheresis without considering hepatic transplantation. We emphasize distinguishing the overlap of symptoms between HELLP syndrome vs. acute fatty liver of pregnancy and the outcomes of plasmapheresis in managing HELLP syndrome without needing hepatic transplantation.