709 - Is the Juice Worth the Squeeze?: Toxidrome due to Illicitly Acquired Anabolic Steroids

Case Diagnosis: Illicit Toxidrome

Case Description: A 35-year-old male with mood disorder and functional neurologic disorder (FND) who was in rehabilitation for deficits related to his FND had a rapid response called by staff due to fever, rigors, significant tachycardia reaching 170 to 180s BPM. Due to the patient's condition and concern for impending sepsis, he was transferred to the acute hospital. Septic workup was completed and negative. After transfer, a bag of injection paraphernalia and bottles labeled as anabolic steroids were found in his room. This led to the concern for anticholinergic/serotonergic toxidrome. Possible offending agents were held. The patient's condition rapidly improved and the patient was discharged home from the acute hospital.

Discussions:
This case highlights the importance of understanding the medications/supplements that patients are consuming, in this instance on the inpatient rehabilitation unit but also in outpatient practice. Our patient was likely experiencing anticholinergic/serotonergic toxidrome, sparked by illegally acquired anabolic testosterone use.

In addition, the direct impact of anabolic steroids may have increased sensitivity to various other medications including opioid narcotics as this has been identified in animal study on mice treated with anabolic steroid. The true contents of this drug could not be properly analyzed. However, if the drug was not found in the patient's room, the patient may have undergone additional evaluation and treatment potentially leading to iatrogenic harm.

Conclusions: Medication interactions are important to consider when evaluating patients, however, it is important to take a complete history of all pharmacologic substances a patient may be utilizing including illicit drugs and supplements. Specifically, anabolic steroids may lead to sensitivity of other medications. Knowledge of this patient's illicit intake helped determine treatment and prevent iatrogenic harm.