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Mysterious death of scared steroids user

We'll probably never know exactly what happened to the 23 year-old bodybuilder who died in St Thomas' Hospital in London. The doctors who tried to save his life wrote an article which will appear soon in Rheumatology International. However, the article raises more questions than it answers. Are there 'bad' steroids on the market? Was the bodybuilder experimenting with lethally dangerous substances? Or did he just have bad luck?

The bodybuilder was born in Sri Lanka, but lived in England and had not travelled anywhere where dangerous diseases are prevalent. The doctors therefore had no reason to suspect viruses or other pathogens when the man arrived at hospital showing pretty bizarre symptoms: he had a cold and the muscles in his upper legs and upper arms were losing strength rapidly. He had a raised creatine kinase level – 28519 U/L – indicating muscle damage. The doctors' diagnosis was inflammation of the muscle fibre as a result of a heavy cold or flu, which had made the man’s immune cells attack his muscles. So the doctors gave the guy prednisolone and methyl prednisolone to suppress his immune cells.

The photo below shows the man's muscle cells under a microscope. The dark patches are inflammations.

Mysterious death of scared steroids user

After five days the bodybuilder's creatine kinase level had gone down. He was released from hospital, only to return again three days later. By now he was even weaker and his creatine kinase level had risen to 52459 U/L. The doctors gave him methyl prednisolone injections again, but this time they didn't help. The guy lost control over his body. When he could no longer talk, the doctors transferred him to intensive care, where they fought for his life for 37 days.

The bodybuilder's creatine kinase level soared to 210,000 U/L. The doctors had to put him on a dialysis machine to fish the organic material from the decomposing muscle cells out of his blood; otherwise his kidneys would have been destroyed.

The man's cold symptoms developed into an infection that caused his lungs to fill up with fluid. Breathing became difficult and pathogens developed in the fluid, which then entered the man's bloodstream. The doctors gave the man breathing assistance, but this was hampered by a new complication. The bodybuilder's abdomen started to swell. An exploratory operation revealed that the man had a severe stomach ulcer and that his gut wall had torn in some places. Faecal material had leaked into his body and was causing infections.

In the end the man died when his heart ceased to function. The doctors tried to reanimate him by operating, but were not successful. The post mortem revealed a heart defect which has been reported a number of times in relation to steroids users. The left ventricle of the bodybuilder's heart was enlarged. Friends and family members reported that the deceased had grown considerably in the previous year, and that he had speculated about the effects that steroids might have on his body. Just before he died, the doctors did ask the man whether he had used steroids. He gave no reply, but asking the question “produced a severe stress response”, the doctors noted. The man was obviously scared. But what about? The answer remains a mystery.

In the absence of other unusual findings, the doctors concluded that steroids had caused inflammatory reactions that led to intensive muscle decomposition. Animal tests have shown that steroids can kill adult muscle cells. Maybe that's what happened to the bodybuilder – as a result of hereditary characteristics? Or was it simply bad luck?

Steroids are useful, but if you use them carelessly they are dangerous, write the doctors. If bodybuilders are so set on using them they should be able to do so under medical supervision. Using products from a reliable manufacturer.

Rheumatol Int. 2009 Oct 27. [Epub ahead of print].

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