1. Clinical case - objective
25 y. caucasian ♂ bodybuilder (188 cm, 92 kg)
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 ( mg ?) Deca Durabolin
Patient’s friend with the similar constitution used the same scheme – no symptoms

2. 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

3. 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

4. Clinical case – outpatient examination
Abdominal echoscopy - normal
TB: ~130→376
DB: ? →299
SGPT/ALT: 90
ALP: 215

5. Clinical case – hospitalization
Arrival 06.16:
Significant jaundice
Ichterus
Scratches and excoriations everywhere
Encephalopaty

9. Clinical case – inpatient examination
TB →436→465→449→564→445
DB →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

10. Clinical case – instrumental investigations
X-ray examination of Thorax – normal
Abdominal echoscopy - normal

11. 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

12. Clinical case – treatment
Prednisolone 1mg/kg
Ornitinum aspartati 18 g p/o
Sylimarins
Neuroleptics
BZD
HBO
Hepatic Diet