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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