Delayed normalisation of presumed stress erythrocytosis in a patient with non-severe alcoholic hepatitis

A middle-aged adult presented with non-severe alcoholic hepatitis after 3 years of daily whisky intake (80–100 mL/day). He was noted to have persistent erythrocytosis (haemoglobin 186 g/L; haematocrit 53.8%) without leucocytosis or thrombocytosis and with normal serum erythropoietin. Secondary causes were evaluated, including hypoxia, cardiac and renal disease, and myeloproliferative neoplasms; Janus Kinase 2 Valine 617 Phenylalanine (JAK2 V617F) and JAK 2 exon 12 testing were negative. Despite intravenous hydration and reported complete alcohol abstinence, erythrocytosis persisted for several weeks after hepatic biochemistry improved. A bone marrow biopsy was planned but deferred when haemoglobin and haematocrit normalised spontaneously by 10 weeks. Overall, the presentation was most consistent with presumed alcohol-associated stress (relative) erythrocytosis, which may show delayed resolution after cessation, and careful longitudinal follow-up may avoid premature invasive investigations once polycythaemia vera and clinically important secondary causes have been reasonably excluded.