Rapid Resolution of Anabolic Androgenic Steroid‐Induced Refractory Pruritus and Bile Cast Nephropathy With Therapeutic Plasma Exchange

ABSTRACT The proportion of non‐paracetamol drug‐induced liver injury (DILI) is increasing in Australia and other Western countries. Androgenic anabolic steroids (AAS) commonly cause a bland cholestasis that can persist for months despite withdrawal. A 35‐year‐old male presented with progressive pain...

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Main Authors: Samuel Wong, Danny Con, Avik Majumdar
Format: Article
Language:English
Published: Wiley 2025-03-01
Series:JGH Open
Subjects:
Online Access:https://doi.org/10.1002/jgh3.70130
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author Samuel Wong
Danny Con
Avik Majumdar
author_facet Samuel Wong
Danny Con
Avik Majumdar
author_sort Samuel Wong
collection DOAJ
description ABSTRACT The proportion of non‐paracetamol drug‐induced liver injury (DILI) is increasing in Australia and other Western countries. Androgenic anabolic steroids (AAS) commonly cause a bland cholestasis that can persist for months despite withdrawal. A 35‐year‐old male presented with progressive painless jaundice associated with pruritus, nausea, loss of weight, dark urine, and pale stools. He had recently commenced AAS; DILI was suspected and confirmed on biopsy. His pruritus was refractory to medical therapy, and PLEX was commenced. He also developed renal failure from bile cast nephropathy (BCN) and required hemodialysis. At 10 weeks post‐discharge, his pruritus and jaundice were significantly improved, and his renal function had completely recovered. The case adds to the growing evidence that PLEX can be used safely and effectively to treat cholestatic pruritus and BCN.
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spelling doaj-art-52fd12f9840f4a19bde03d835e97d18d2025-08-20T02:41:55ZengWileyJGH Open2397-90702025-03-0193n/an/a10.1002/jgh3.70130Rapid Resolution of Anabolic Androgenic Steroid‐Induced Refractory Pruritus and Bile Cast Nephropathy With Therapeutic Plasma ExchangeSamuel Wong0Danny Con1Avik Majumdar2Liver Transplant Unit, Department of Gastroenterology Austin Health Heidelberg Victoria AustraliaLiver Transplant Unit, Department of Gastroenterology Austin Health Heidelberg Victoria AustraliaLiver Transplant Unit, Department of Gastroenterology Austin Health Heidelberg Victoria AustraliaABSTRACT The proportion of non‐paracetamol drug‐induced liver injury (DILI) is increasing in Australia and other Western countries. Androgenic anabolic steroids (AAS) commonly cause a bland cholestasis that can persist for months despite withdrawal. A 35‐year‐old male presented with progressive painless jaundice associated with pruritus, nausea, loss of weight, dark urine, and pale stools. He had recently commenced AAS; DILI was suspected and confirmed on biopsy. His pruritus was refractory to medical therapy, and PLEX was commenced. He also developed renal failure from bile cast nephropathy (BCN) and required hemodialysis. At 10 weeks post‐discharge, his pruritus and jaundice were significantly improved, and his renal function had completely recovered. The case adds to the growing evidence that PLEX can be used safely and effectively to treat cholestatic pruritus and BCN.https://doi.org/10.1002/jgh3.70130anabolic steroidsbile cast nephropathybland cholestasisdrug‐induced liver injuryplasma exchange
spellingShingle Samuel Wong
Danny Con
Avik Majumdar
Rapid Resolution of Anabolic Androgenic Steroid‐Induced Refractory Pruritus and Bile Cast Nephropathy With Therapeutic Plasma Exchange
JGH Open
anabolic steroids
bile cast nephropathy
bland cholestasis
drug‐induced liver injury
plasma exchange
title Rapid Resolution of Anabolic Androgenic Steroid‐Induced Refractory Pruritus and Bile Cast Nephropathy With Therapeutic Plasma Exchange
title_full Rapid Resolution of Anabolic Androgenic Steroid‐Induced Refractory Pruritus and Bile Cast Nephropathy With Therapeutic Plasma Exchange
title_fullStr Rapid Resolution of Anabolic Androgenic Steroid‐Induced Refractory Pruritus and Bile Cast Nephropathy With Therapeutic Plasma Exchange
title_full_unstemmed Rapid Resolution of Anabolic Androgenic Steroid‐Induced Refractory Pruritus and Bile Cast Nephropathy With Therapeutic Plasma Exchange
title_short Rapid Resolution of Anabolic Androgenic Steroid‐Induced Refractory Pruritus and Bile Cast Nephropathy With Therapeutic Plasma Exchange
title_sort rapid resolution of anabolic androgenic steroid induced refractory pruritus and bile cast nephropathy with therapeutic plasma exchange
topic anabolic steroids
bile cast nephropathy
bland cholestasis
drug‐induced liver injury
plasma exchange
url https://doi.org/10.1002/jgh3.70130
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AT dannycon rapidresolutionofanabolicandrogenicsteroidinducedrefractorypruritusandbilecastnephropathywiththerapeuticplasmaexchange
AT avikmajumdar rapidresolutionofanabolicandrogenicsteroidinducedrefractorypruritusandbilecastnephropathywiththerapeuticplasmaexchange