Intramuscular Abscess

Counterfeiting in performance- and image-enhancing drugs

The current drastic escalation in obesity may be contributing to the exponential rise in drugs used for image enhancement. Drugs such as anabolic-androgenic steroids (AAS) are perceived as a viable method of achieving a perfect physique. They are also the most widely abused drugs in sport. The Internet has encouraged the abuse of expensive drugs, particularly human growth hormone (hGH), resulting in increased importation for personal use. The substantial increase in this market has opened up avenues for counterfeiting, estimated as a multi-million pound business. The acute adverse effects from contaminated vials may result in a variety of pathologies including communicable diseases. In 2007, in the UK, a series of intramuscular abscesses, requiring surgical treatment, led us to study samples obtained from the underground market. The analysis of 38 parenteral samples and 19 oral samples of tablets was performed by a World Anti-Doping Agency (WADA) accredited laboratory, in an attempt to establish the extent of available counterfeit products. Fifty-three per cent (20) of the injectable AAS esters and 21% (4) of the oral tablets were counterfeit. Culture and sensitivity revealed the presence of skin commensal organisms, which may have contributed to the development of the abscesses. Users of AAS and hGH for sport, including bodybuilding, are currently risking their health because of counterfeit and poorly controlled products.

Abscess related to anabolic-androgenic steroid injection

One million individuals in the United States, predominantly males under 25 yr of age, are current or past users of anabolic-androgenic steroids. Fifty percent of these young adults administer their drugs intramuscularly, placing them at risk for infections related to injection. We present here a case report of an injection-related thigh abscess in a 26-yr-old anabolic steroid injector who did not use sterile injection technique and reported sharing multidosage vials with two other weightlifting colleagues. Reported infections associated with anabolic-androgenic steroid injection include abscesses attributable to Mycobacterium smegmatis, Staphylococcus, Streptococcus, and Pseudomonas organisms as well as HIV, hepatitis B, and hepatitis C. These infections are primarily related to nonsterile injection technique, shared injection equipment, and are avoidable with appropriate prevention techniques. Education is needed to prevent infectious complications such as abscesses and blood-borne pathogens among anabolic-androgenic steroid injectors.