Delayed Severe Drug Induced Cholestasis After Anabolic Steroids Exposure

Anabolic steroids therapy is linked to a distinctive form of acute cholestasis that generally arises within 1 to 4 months of starting therapy but may be delayed to as long as 6 to 24 months in some reported cases. We are presenting an unusual case where acute cholestasis happened 5 weeks after discontinuing short course (7 days) of anabolic steroids.A 20-year-old African American male without significant past medical history presented with jaundice, mild nausea and generalized pruritis. He admitted to self-initiation of oral Stanozolol 40 mg daily for 7-days about 5 weeks before his admission. No prior incidence and no significant alcohol use. Vitals signs unremarkable and physical exam was unremarkable except for jaundice and sclera icterus. No hepatosplenomegaly. Liver function profile with ALT 44 IU/L, AST 72 IU/L, ALP 266 IU/L, & total bilirubin of 21.4 mg/Dl. Extensive hepatitis workup was negative and a CT-guided liver biopsy was performed which showed marked hepatocanalicular cholestasis. This is reflective of drug induced cholestasis.Our case highlights the possibility of delayed liver injury even after a short anabolic steroids course which typically happen while taking the medication for an extended period (more than 1 month).