P81 | Jaundice at the gym, a case report

M. Guarascio, E. Colizzi, A. Panico, A. Costa, P. Berchicci, F. Parente | UO Medicina Interna, Ospedale Vito Fazzi, Lecce, Italy

Background: Synthetic anabolic steroids have gained extensive utilization for augmenting exercise and athletic performance, demonstrating the potential to induce cholestatic liver injury. Conversely, phytoecdysteroids are traditionally presumed to lack this hepatotoxicity. Is this always true?
Case report: An athletic 22 y.o. male, who has been engaging in anabolic supplementation with phytoecdysteroids for more than one month, manifested symptoms including pruritus, dark urine, and jaundice, necessitating clinical assessment. Laboratory testing revealed elevated levels of bilirubin, predominantly in the direct fraction, as well as increased levels of ALP, AST, ALT, and GGT. Abdominal magnetic resonance imaging (MRI) was conducted, revealing a reduction in the diameter of the common bile duct. Subsequent endoscopic retrograde cholangiopancreatography did not identify any pathological findings. The high bilirubin levels necessitated repeated sessions of apheresis. Intravenous hydration and ursodesoxycholic acid have been administered with benefit. The investigation into secondary causes of hepatobiliary inflammation has been initiated, ruling out infectious etiology (negative for HBV, HCV, CMV, EBV, WW) or autoimmune diseases (negative for ANA, AMA, ASMA, Anti-LKM, ANCA, ENA), confirming hepato-cholangitis as a result of anabolic steroid use.
Conclusions: Notwithstanding their favorable characterization in the literature, prudence is imperative when dealing with dietary supplements containing phytoecdysteroids, given the potential risk of inducing severe hepato-cholangitis.