2020
DOI: 10.1136/bmjgast-2020-000549
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Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Abstract: BackgroundAnabolic androgenic steroids (AAS) usage is widespread and increasing. AAS drug-induced liver injury (DILI) is recognised but its clinical course and management is poorly described. We report 2 cases of AAS DILI with associated renal dysfunction, managed successfully with oral corticosteroids.MethodsA comprehensive review identified 50 further cases to characterise the clinical and biochemical course. Causality grading was calculated using the updated Roussel Uclaf Causality Assessment Method (RUCAM)… Show more

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Cited by 17 publications
(25 citation statements)
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References 34 publications
(40 reference statements)
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“…Overall, five cases due to amoxicillin-clavulanate induced liver injury receiving UDCA ( Chawla et al, 2000 ; Katsinelos et al, 2000 ; Studniarz et al, 2012 ; Ahmed et al, 2020 ) have been reported ( Table 1 ). Furthermore, three associated to androgenic anabolic steroid (AAS) ( Sánchez-Osorio et al, 2008 ; Krishnan et al, 2009 ; Stępień et al, 2015 ), three cases due to the combination of AAS and dietary supplements ( Singh et al, 1996 ; El Khoury et al, 2017 ; Abeles et al, 2020 ), three due to Centella asiatica ( Jorge and Jorge, 2005 ), two associated with immune check point inhibitors ( Kurokawa et al, 2019 ; Onishi et al, 2020 ), one reaction each due to terbinafine ( Agca et al, 2004 ), flutamide ( Cicognani et al, 1996 ), ibandronate ( Goossens et al, 2013 ), brentuximab vedotin ( Neeman et al, 2019 ), methimazole ( Gallelli et al, 2009 ), and Kratom that were treated with UDCA ( Fernandes et al, 2019 ).…”
Section: Resultsmentioning
confidence: 99%
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“…Overall, five cases due to amoxicillin-clavulanate induced liver injury receiving UDCA ( Chawla et al, 2000 ; Katsinelos et al, 2000 ; Studniarz et al, 2012 ; Ahmed et al, 2020 ) have been reported ( Table 1 ). Furthermore, three associated to androgenic anabolic steroid (AAS) ( Sánchez-Osorio et al, 2008 ; Krishnan et al, 2009 ; Stępień et al, 2015 ), three cases due to the combination of AAS and dietary supplements ( Singh et al, 1996 ; El Khoury et al, 2017 ; Abeles et al, 2020 ), three due to Centella asiatica ( Jorge and Jorge, 2005 ), two associated with immune check point inhibitors ( Kurokawa et al, 2019 ; Onishi et al, 2020 ), one reaction each due to terbinafine ( Agca et al, 2004 ), flutamide ( Cicognani et al, 1996 ), ibandronate ( Goossens et al, 2013 ), brentuximab vedotin ( Neeman et al, 2019 ), methimazole ( Gallelli et al, 2009 ), and Kratom that were treated with UDCA ( Fernandes et al, 2019 ).…”
Section: Resultsmentioning
confidence: 99%
“…DILI diagnosis was performed by original authors. Most of DILI case reports had an extensive panel of serological, autoantibodies and image test and even biopsy findings to rule out alternative causes of liver injury before the DILI diagnosis, however only in two cases Roussel Uclaf Causality Assessment Method (RUCAM) ( Danan and Benichou, 1993 ) was applied for DILI assessment ( Gallelli et al, 2009 ; Abeles et al, 2020 ) (4 points, possible and 6 points, probable association to the drug, respectively) and in one case Naranjo scale ( Naranjo et al, 1981 ) was applied ( Agca et al, 2004 ) (probable relationship to the drug). Even assuming all of them are true DILI cases, none of the authors compared the time to resolution of their cases with other DILI cases not treated with UDCA.…”
Section: Resultsmentioning
confidence: 99%
“…However, there has been a trend of increased AAS DILI reporting in recent years which may lead to new insights into pathophysiology and disease course. According to currently available data, AAS DILI has a good prognosis as the majority of cases recover completely and only a very small number of cases develop hepatic failure or die[ 39 ].…”
Section: Hepatotoxicitymentioning
confidence: 99%
“…Such characteristics are indicative of cholestasis with minimal inflammation of the liver or bile duct. Resolution usually occurs upon discontinuation of anabolic steroids, although some case reports indicate benefits of hydrocortisone and ursodeoxycholic acid treatment[ 13 , 39 - 42 ].…”
Section: Cholestasismentioning
confidence: 99%
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