A bodybuilder presented with skin necrosis on the buttocks bilaterally.
A 35-year-old man presented to the emergency room with complaints of painful skin necrosis over both his buttocks. The patient was otherwise healthy and had no other symptoms. His past medical history did not reveal any chronic disease.
Social history revealed that he is a recreational ‘bodybuilder’ for which he uses illicit substances to rapidly gain muscle mass. Three weeks before presenting to the emergency department, he had started taking a new steroid, Trenbolone, although he had been taking other anabolic steroids and testosterone for the past 4 years.
On examination, the patient was alert, oriented, and conscious. Physical examination of the buttocks revealed painful skin necrosis on both buttocks with purulent discharge. The wound on the left buttock measured approximately 5 x4 cm, and on the right buttock, it measured around 6.5x 4 cm. the necrosis had involved the skin, subcutaneous fat, a small part of the gluteus maximus muscle too.
Samples were taken from both the wounds for culture, which grew Staphylococcus aureus.
The patient was treated locally with mafenide acetate irrigation and wound dressings. The patient was discharged with clear instructions and counseling.
Three weeks later, the patient came for a follow-up. On examination during the follow-up visit, the wound seemed to be healing with adequate granulation tissue filling and peripheral epithelialization. The wound margins were observed to have shrunken. The left one measured 3.5 x 3 cm, and the wound on the right measured 5 x 3 cm.
At the 6-week-follow-up, the wound dressings were changed to polyurethane, and complete epithelialization was observed 2 months after the patient was discharged.
Thereafter, the patient had no further complications.
