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21.02.2013

Steroids use masked TB in bodybuilder

A 40-year-old fitness fanatic walked around for years with a potentially lethal TB infection without knowing it. The reason that the infection was not discovered was his continuous use of the steroid nandrolone decanoate. It wasn't until the man developed extreme stomach pains and sought medical help that doctors stepped in.

The fitness fanatic that doctors in Srinagar Garhwal, India have written about in the Journal of Pharmacology & Pharmacotherapeutics had probably been ill for three months. He had stopped training, had lost his appetite and was tired and lacking in energy.

These can be early symptoms of infection caused by the TB bacterium Mycobacterium tuberculosis. The infection hadn't been detected, as the man had not visited a doctor. Instead he followed the advice of a fellow gym-goer. No prizes for guessing what that was... "Take some steroids", his mate advised.

And that's what the man did. He started with one 100 mg injection of nandrolone decanoate per week. And hey presto: after three months he felt better. He started doing workouts again, and a month later he stopped the injections. Things went wrong immediately. The symptoms returned and the man started to feel depressed too, and was dismayed to see his muscles disappearing like snow melting in the sun.

So he started taking steroids again: first 3 injections a month, later 6 or 7 injections a month. And he was pleased with the results: the steroids were improving his physique. After a year of being on steroids the man noticed that he ran a fever in the evenings. He went to a doctor, who suspected TB. A skin test showed up nothing, however, and the man didn't mention his steroids use.

This was the second time that the steroids had prevented doctors from detecting the presence of TB bacteria. The doctor used the tuberculin skin test: you introduce tuberculin protein from the TB bacteria under the skin. If the immune cells in your body have been in contact with the TB bacteria then your skin will react within a couple of weeks. The immune reaction is prompted by inflammatory proteins like interferon-gamma. But a steroid like nandrolone decanoate suppresses the immune system, and as a result the tuberculin skin test doesn't work. Nandrolone decanoate inhibits the production of interferon-gamma.

The doctor prescribed fever-reducing medicine together with multivitamins.

Five months later the man's condition had deteriorated: he had extreme stomach pain and was vomiting, so he went to the emergency department at a hospital. On examination a doctor felt something in the man's lower abdomen. The man's appendix was infected, as was a lymph gland in his abdomen, and together they were constricting his intestines.

Surgeons operated and sent the tissues they'd removed for examination in a laboratory. There the researchers discovered the cause of his problems: TB infection.

The man was put on antibiotics for six months, which killed the TB bacteria and cured him. He also went into therapy to try and work out how he had become psychologically dependent on steroids. "He disclosed that since his wife was tall and obese, he found himself more physically and sexually compatible with her while on AAS."

TB is on the rise in many countries. The bacteria have become resistant to antibiotics. TB infection occurs in the light-coloured areas on the map below. In the dark-coloured areas infection is common, in the white areas TB is rare.

It's not the first time that a steroids user has run into problems because TB tests don't work. The researchers also think that "anabolic androgenic steroids should be added to list of factors causing false negative tuberculosis skin test".

Source:
J Pharmacol Pharmacother. 2012 Oct;3(4):345-7.

More:
Deca-use may hide tuberculosis 13.09.2009