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Fatal Form of COVID-19 in a Young Male Bodybuilder Anabolic Steroid Using: The First Autopsied Case

Costel Vasile Siserman1,2, Ionuț Isaia Jeican3,4, Dan Gheban5,6

  • 1Institute of Legal Medicine, 400006 Cluj-Napoca, Romania.

Medicina (Kaunas, Lithuania)
|October 27, 2022
PubMed

Insights

A bodybuilder with a 16-year history of anabolic androgenic steroid (AAS) abuse died from severe COVID-19. His death resulted from a combination of genetic predisposition, long-term AAS use, and recent AAS consumption impacting his immune response.

Area of Science:

  • Forensic Pathology
  • Toxicology
  • Infectious Diseases

Background:

  • Anabolic androgenic steroids (AASs) are performance-enhancing drugs with known cardiovascular risks.
  • Long-term AAS abuse can lead to significant systemic health issues.
  • The interaction between AASs, genetic factors, and viral infections like COVID-19 is not fully understood.

Observation:

  • A 34-year-old male, a bodybuilding trainer with 16 years of AAS use, presented with cardio-respiratory arrest.
  • Autopsy revealed severe COVID-19, aortic atherosclerotic plaques, and prior myocardial infarction.
  • Histopathology showed microthrombi, endothelitis, pulmonary edema, diffuse alveolar damage, thromboembolism, hepatic peliosis, and nesidioblastosis.

Findings:

  • SARS-CoV-2 (B.1.258 lineage) was detected in lung tissue.
  • Immunohistochemistry confirmed SARS-CoV-2 and ACE-2 receptor presence in multiple organs including myocardium, lungs, kidneys, pancreas, spleen, and liver.
  • Specific HLA alleles (A*03, A*25, B*18, B*35, C*04, C*12, DRB1*04, DRB1*15, DQB1*03, DQB1*06) were identified.

Implications:

  • The case highlights a potential multifactorial cause of death involving genetic predisposition, chronic AAS abuse, and acute viral infection.
  • AASs may create a "pluriorganic pathological tissue terrain" predisposing individuals to severe outcomes from infections.
  • Recent AAS use could modulate the immune system, exacerbating viral pathogenesis and contributing to sudden death.

Keywords:
COVID-19anabolic androgenic steroidsautopsyrisk factortestosterone

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