An Atypical Presentation of Pulmonary Oedema Secondary to Suspected Anabolic Steroid-Induced Cardiomyopathy

A case report of a patient presenting with acute shortness of breath and chest pain, on a background of anabolic-androgenic steroid (AAS) use. An initial chest radiograph and a CT scan showed bilateral pulmonary infiltrates suggestive of atypical infection or lung malignancy. However, further evaluation confirmed these findings to be due to cardiogenic pulmonary oedema resulting from left ventricular failure, secondary to suspected anabolic steroid-induced cardiomyopathy. The patient's symptoms improved following the initiation of guideline-directed medical therapy for heart failure, in conjunction with oral diuretics. Further MRI imaging confirmed a significantly hypertrophied left ventricle with marked systolic dysfunction. Whilst excluding an ischaemic cardiomyopathy as the cause, it did also suggest the presence of a bystander infarct. This case highlights the spectrum of cardiovascular disease that can develop with prolonged use of anabolic steroids and underscores the heterogeneous radiological presentations of acute pulmonary oedema.