Clinical case - objective

• 25 y. caucasian ♂ bodybuilder (188 cm, 92 kg)• 2006.04. starts AS according the scheme:

– 1 pill (5 mg) Nerobol (Methandienone) 3 time/day I week– 4 time/day II week– 5 time/day III week– 6 time/day IV week – and 1 amp Deca Durabolin (Nandrolone)

each 5 days i/m

• Total per 2 monts 240 pills (1200 mg) Nerobol and 8 amp (400-800 mg ?) Deca Durabolin

• Patient’s friend with the similar constitution used the same scheme – no symptoms

Clinical case – first symptoms

• No any symptoms for 2 months• After 2 months:

– headache– loss of appetite– insomnia– disphagia

• Loss of weight (15 kg during 5 weeks)• Increasing itch and jaundice

Clinical case – outpatient treatment• Risk factor – physicians in family :

– Infectionist – no infections– Reumatologist – no autoimmune disease

• Medications:– loratadinum 10 mg p/o– ornitinum aspartate 9 g p/o– BZD

Clinical case – outpatient examination

• Abdominal echoscopy - normal

• TB: ~130→376

• DB: ? →299

• SGPT/ALT: 90

• ALP: 215

Clinical case – hospitalization

• Arrival 06.16:– Significant jaundice– Ichterus– Scratches and excoriations everywhere– Encephalopaty

Clinical case – inpatient examination • TB 564→436→465→449→564→445• DB 460 →368→363→394→491→381• SGPT/ALT 75 →66→91→64→83→82• SGOT/ASAT 286 →106→67→54→59→62• ALP 284 →228→234→193→232→184• CRP not found• CBC normal levels• Total Ch 4,4 → 4,01• HDL Ch 0,35 → 0,08 (normal level >1)• LDL Ch 3,74 → 3,94• TG 3,49 → 3,82

Clinical case – instrumental investigations

• X-ray examination of Thorax – normal

• Abdominal echoscopy - normal

Clinical case – echocardiography

• Decreased LV ejection fraction 40% (normal value >55%), hypokinesis in LV inferior and inferolateral wall and interventriculum septum bottom segments. Damaged diastolic function of LV

Clinical case – treatment

• Prednisolone 1mg/kg

• Ornitinum aspartati 18 g p/o

• Sylimarins

• Neuroleptics

• BZD

• HBO

• Hepatic Diet