A very typical case of severe cholestasis due to anabolic steroid use. Because the steroids were being used without medical supervision, the dose and actual duration of use of each preparation was unclear, but cholestasis usually arises within 4 to 12 weeks of starting a C-17 alkylated androgenic steroid. The jaundice can be severe and prolonged and accompanied by severe pruritus and marked weight loss. The serum enzymes are typically minimally elevated except for a short period immediately after stopping therapy. The pattern of enzyme elevations can be hepatocellular, cholestatic or mixed. Liver biopsy shows a “bland” cholestasis with minimal inflammation and hepatocellular necrosis. Ma Huang has also been implicated in cases of drug induced liver injury, but is associated with an acute hepatocellular pattern of injury.
Despite hitting a career-high 46 home runs in 1998, Canseco drew minimal attention in the free agent market. In 1999, he signed a three-year contract with the Tampa Bay Devil Rays . The contract included a clause stating that if Canseco were to be elected to the Hall of Fame he would be depicted as a member of the Devil Rays. That year he took the American League by storm, hitting 10 home runs in April, and leading the AL with 31 by the All-Star break (including number 400 for his career against Toronto's Kelvim Escobar). On pace for 60+ homers for the season, he was voted to the AL All-Star team as the DH, making his first All Star selection in 7 years. However, he injured his back days before the mid-summer classic and missed the game, as well as the Home Run Derby in Fenway Park. He finished the season with 34 home runs for the 1999 season.