Steroid Hepatotoxicity-Peliosis, Cholestasis, and Secondary Iron Overload?

Anabolic steroid use continues to rise, especially among bodybuilders, bringing with it a wide range of liver complications. We present the case of a 34-year-old healthy male who developed jaundice, dark urine, and pale stools after taking unprescribed anabolic steroids for six weeks. His labs showed elevated bilirubin and alkaline phosphatase. While imaging revealed vascular liver lesions, a liver biopsy confirmed bland cholestasis, peliosis hepatis, and unexpectedly iron deposits, despite negative genetic testing for hemochromatosis. While cholestasis and peliosis are recognized effects of steroid use, the presence of iron buildup in the liver without a genetic cause suggests a possible new mechanism of injury. It may reflect inflammatory changes or altered iron metabolism in the setting of peliosis.