Bodybuilding - a remarkable recovery

Abstract

A 43-year-old bodybuilder with a history of anabolic steroid abuse was admitted having been found unresponsive. Examination revealed antecubital fossae contusions but was otherwise unremarkable, as were all initial investigations. Deteriorating Glasgow Coma Score necessitated tracheal intubation. Early attempts at weaning from mechanical ventilation coincided with marked haemodynamic instability and decerebrate posturing to pain with upgoing plantar responses. The patient subsequently became almost completely areflexic, although corneal reflexes were preserved and spontaneous breathing remained. An electroencephalogram showed evidence of a non-specific toxic or metabolic encephalopathy, despite a negative toxicology screen and consistently normal imaging. In the following weeks, a gradual spontaneous improvement occurred. Fourteen weeks after admission, the patient walked out of hospital having made an almost complete recovery. Possible causative factors are discussed, as well as the complications and challenges of managing bodybuilders abusing anabolic agents. These patients require both vigilance and an open mind, as the potential for complications is varied and potentially multi-systemic. © The Intensive Care Society 2010.