VCOM Louisiana Research Day Program Book 2024

Clinical Research

Marissa Di Napoli, MD; Atef Haifa, OMS-IV; Zibari Gazi, Veron Browne, MD; Greg Wellman, MD Amiri Hossein, MD Willis-Knighton Health System 35 LIVER TRANSPLANTATION FOR FULMINANT HEPATIC FAILURE SECONDARY TO ANABOLIC ANDROGENIC STEROID USE: A CASE REPORT AND REVIEW OF LITERATURE

Background: Trenbolone acetate is an anabolic androgenic steroid (AAS) used in the livestock industry to increase the rate of weight gain in cattle being raised for slaughter. However, it is commonly abused by fitness enthusiasts for its performance enhancing effects. The liver is the main organ for steroid metabolism and clearance and the hepatotoxic effects of AAS are well documented in the literature. Transient elevations in serum enzymes and acute cholestatic injury are usually self-limiting and resolve with supportive care. We report the rare case of a previously healthy 30-year-old male who underwent liver transplantation for fulminant hepatic failure due to suspected drug induced liver injury from Trenbolone. The patient presented to the Emergency Department with fever, generalized body aches, and a petechial rash over the bilateral lower extremities. His initial labs showed severe elevation in liver function tests, thrombocytopenia, and acute kidney injury. He was admitted to ICU and despite aggressive supportive measures, the patient’s condition continued to deteriorate. He was listed for liver transplant with Status 1A and underwent successful transplantation 3 days after initial presentation. Eliciting the cause of this patient’s liver failure was challenging, as his laboratory

studies were not consistent with the typical cholestatic pattern seen with AAS induced hepatotoxicity. However, we are confident that this patient’s hepatic failure resulted from Trenbolone as history and extensive laboratory testing failed to determine an alternative cause. To our knowledge this is the first documented cases of AAS induced hepatotoxicity progressing to fulminant hepatic failure requiring transplantation for survival.

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