Hemoptysis and Anabolic Steroids: A Case Report of Oxandrolone-Induced Bleeding

BACKGROUND Anabolic androgenic steroids (AAS) are associated with multiple adverse effects. They can cause thrombotic as well as hemorrhagic manifestations. Oxandrolone is one such AAS that used to be approved by the FDA for treatment of malnutrition and weight loss following severe burn injury, trauma, HIV-related wasting and neuromuscular disorders. It was previously inappropriately used by athletes for muscle build-up. Recently, the FDA withdrew approval over safety and efficacy concerns. CASE REPORT A 20-year-old otherwise healthy man presented with a 4-day history of early-morning hemoptysis. He had recently used oxandrolone for supplementing muscle growth. Hemoptysis was witnessed by hospital staff. Flexible nasopharyngolaryngoscopy demonstrated easy bleeding without a localized lesion. Hemoptysis progressively declined during hospitalization, and eventually completely resolved. CONCLUSIONS Anabolic androgenic steroids can lead to bleeding manifestations in otherwise healthy patients, which resolve upon cessation of use. A thorough evaluation of all medications, prescribed or otherwise, is particularly important when dealing with unusual presenting symptoms. AAS might not appear on standard medication reconciliation sections in electronic medical records or on basic toxicology screen results. Further research is needed to elucidate factors that can influence bleeding versus thrombotic manifestations.