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