ORAL PRESENTATIONS – RESIDENTS SESSION 1
BEEFING UP! FULMINANT LIVER FAILURE SECONDARY TO ANABOLIC STEROID USE Natasha Santosh, MD; Saloni Savani, MD; Srinivasa Iskapalli, MD- Willis Knighton Medical Center, Shreveport, LA.
Introduction: Trenbolone is an anabolic steroid used as a veterinary steroid in cattle and is often abused by fitness enthusiasts to increase muscle mass. Anabolic steroids have been known to cause psychological, neurological, endocrine, and cardiovascular disturbances. Here we present a case of fulminant hepatic failure in a young male with history of trenbolone and testosterone use who survived after receiving timely orthotopic liver transplantation. Case: A previously healthy, well developed, 30-year- old male presented with right upper quadrant pain, body aches for 2 days after he developed a fever of 103oF and petechial rash on his hands and feet. He consumed alcohol occasionally and denied smoking or recreational drug use. He admitted using trenbolone for bodybuilding. He was found to have thrombocytopenia, renal impairment, and markedly elevated liver function tests. Infectious, autoimmune, vascular, and other toxicological causes of fulminant liver failure were ruled out and his liver failure was attributed to his trenbolone use. He developed coffee ground emesis and altered mental status. He was intubated for airway protection, required vasopressor support, and received multiple units
of blood products. Continuous renal replacement therapy was initiated which helped stabilize his blood pressure. He received a liver transplant on day 6 of admission. Pathology of native liver revealed hepatocellular necrosis with a 2.5 cm benign hemangioma. Recovery was complicated by cerebral edema and continued bleeding at the surgical site which subsequently resolved. The patient was able to discontinue hemodialysis after 6 sessions. A polyuric phase of renal recovery was noted leading to suspicion of ATN secondary to bile cast nephropathy in addition to hepatorenal syndrome. The patient continued to recover with physical therapy and was able to walk independently upon discharge. Discussion: Previous case reports of acute liver disease associated with anabolic steroids describe a transient elevation of liver enzymes. This is the first reported case of fulminant hepatic failure secondary to anabolic steroid use treated successfully with orthotopic liver transplant. Awareness of recent fitness fads can help medical professionals educate patients about the risks of unauthorized drug use and offer safer alternatives.
ABNORMAL CARDIAC CONDUCTION ABNORMALITIES AS THE PRESENTING SIGN OF PYRETHROID POISONING Neha Bapatla MD, William Rothwell MD; Department of Medicine. Tulane University, New Orleans, LA.
Introduction: Pyrethroids are a type of synthetic insecticide seen in common household products. Toxicity with this agent mimics organophosphate poisoning and presents predominantly with neurologic and gastrointestinal manifestations. Cardiotoxicity associated with pyrethroid poisoning is an underreported phenomenon for which its mechanism of action is poorly understood. Case: The patient displayed nonspecific symptoms after experiencing dermal absorption of Raid. Initial EKG obtained revealed a T wave inversion in lead III but was otherwise unremarkable; however, the rhythm strip obtained indicated a premature atrial complex that degenerated into an irregular
tachycardia. Ultimately, this patient’s rhythm oscillated between normal sinus rhythm, sinus bradycardia, and atrial tachycardia with persistent hypotension. The diagnosis was nearly missed due to the abnormal presentation, but fortunately, the cardiac conduction abnormalities and history allowed the medicine team to facilitate a transfer of care to the medical intensive care unit. The patient was treated with a pralidoxime infusion with immediate resolution of cardiac conduction abnormalities. He was discharged in stable condition within a few days with complete resolution of all symptoms and laboratory abnormalities.
Discussion: Cases detailing cardiotoxicity because
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