Integrating forensic pathology and toxicology for in-depth analysis of performance-enhancing substance misuse: Insights into injury, death, and broader implications

The death of a non-professional bodybuilder with a history of performance-enhancing drug (PED) use was thoroughly investigated. At the decedent's residence, investigators found four boxes of methylprednisolone tablets, one galenic preparation of sibutramine, and two unlabelled galenic compounds. Blood and hair samples were collected during autopsy. Toxicological analysis revealed the presence of methylprednisolone (19 ng/mL), methandrostenolone (27 ng/mL), and sibutramine (29 ng/mL) in blood. Hair analysis confirmed sibutramine (80 pg/mg) and methandrostenolone (1.28 ng/mg). GC-MS analysis of the seized substances detected methylprednisolone, sibutramine, and methandrostenolone in varying concentrations, highlighting cross-contamination during preparation. Death was related to a right cerebral endoventricular hemorrhage secondary to a ruptured subarachnoid arteriovenous malformation (AVM). The hypertensive peaks associated with weightlifting likely contributed to rupture of the weakened AVM walls. Indeed, histopathological analysis revealed myxoid parietal degeneration which was related to chronic hypertension induced by prolonged use of anabolic-androgenic steroids (AAS) and sibutramine. Evidence suggested that sibutramine was consumed both from labelled products and inadvertently from unlabelled compounds, highlighting safety concerns regarding the unregulated and poorly labelled substances. This case underscores the significant health risks associated with PED use, particularly in non-professional contexts where anti-doping measures are absent.