An unusual cause of encephalopathy with renal failure in a patient with treated HCV cirrhosis.

A 63-year-old teetotaller male, previously treated for hepatitis C-related compensated cirrhosis, presented with acute-onset encephalopathy with no focal neurological deficit and stable vitals. Investigations revealed elevated serum creatinine (2.94 mg/dL), hypercalcemia, hypophosphatemia, and high serum PTH levels. He was diagnosed with right parathyroid adenoma (1.3×1.2×0.7 cm) with the help of a neck ultrasound. His encephalopathy and renal failure persisted despite adequate IV fluids, calcitonin, and bisphosphonates. Urgent hemi-parathyroidectomy was performed on day four, following which he recovered completely.

A Disquiet Find: Anabolic-androgenic steroids and Vanishing Bile Duct Syndrome.

A common practice among young athletes and body-builders is the adoption, use, and self-administration of androgenic anabolic steroid commonly referred to as AASs. Prime classification of these anabolic steroids is either testosterone or synthetic testosterone derivatives. They are primarily used for performance and endurance enhancement. However, the use of steroids is not without adverse effects. Steroid-induced liver diseases may range from chronic hepatitis to vascular or bile ductular injury and death. Presented herein is a case of Vanishing Bile Duct Syndrome due to the anabolic steroid consumption by a young, healthy male.