Corticosteroids use to treat stanozolol and nsaids induced hepatotoxicity

case report

Abstract

Introduction: Drug-induced liver injury (DILI) may be due to several agents. It is classified as dose-dependent or idiosyncratic, depending on the characteristics of the drug and the user. Based on a case report and based on a literature review, we will discuss the pathogenesis of LHID, the immunological modulation triggered by the drug and the use of corticosteroid therapy. Case presentation: A 28-year-old patient used the anabolic steroid stanozolol for one month and then diclofenac for two weeks. He developed cholestasis and increased transaminases, with reagent antinuclear antibodies. Viral hepatitis, HIV, syphilis, autoimmune hepatitis, hemochromatosis were excluded and abdominal ultrasound was normal. Due to the progressive increase in bilirubin levels, despite the suspension of drugs, as well as a new increase in transaminases, it was decided to start prednisone. He presented clinical improvement and decrease of serum bilirubin but maintained a considerable increase in transaminases and canalicular enzymes were still above the reference value. Liver biopsy was performedand revealed cholestatic hepatitis. After weaning from corticosteroids, the patient remained asymptomatic, with normal biochemistry. Discussion: We present a case of mixed LHID after the association of anabolic steroid and non-steroidal anti-inflammatory drugs. Corticosteroid therapy was performed due to the possibility of autoimmune-like LHID or idiopathic autoimmune hepatitis triggered by drugs. The biopsy was not conclusive about any of the conditions. The patient improved with corticosteroids and remained asymptomatic without this drug. We believe that corticosteroid therapy can reduce disease duration in patients at risk for chronicity.