The Death of a Male Musician With a Mysterious Malady

Albert B. Lowenfels, MD

Disclosures

October 03, 2007

Introduction

The patient was a 35-year-old white male professional musician and composer with a brief acute terminal illness superimposed on a lifetime history of medical disorders. He was 5 feet 4 inches (154 cm) tall, slightly built, and had pock-marked skin from an attack of smallpox.

Medical and Family History

The patient was one of 7 siblings, but only the patient and his older sister survived childhood. His father died at age 67 from suspected heart disease and his mother died at age 58, possibly from an acute gastrointestinal disturbance. Only 2 of the patient's 6 children survived to adulthood.

By the age of 10 the patient had sustained several bouts of a febrile illness in which fever, sore throat, and joint pain were prominent symptoms. When he was 11 years old he contracted smallpox, which left permanent facial scarring, and at age 16 he had an attack of jaundice. In his late 20s he experienced recurrent attacks of joint pain and abdominal colic. As an adult, he consumed alcohol, often in large amounts. Occasionally he smoked a pipe.

In the weeks preceding his death, the patient was depressed, had headaches, and lost weight. He also had delusions of being poisoned. During the final 2 weeks, he experienced weakness, fever, episodes of vomiting, abdominal pain, diarrhea, and widespread edema. Although obviously ill, he continued to work on his final composition -- a requiem. He remained alert until a few hours before his death, when he became comatose. A physician performed a mandatory limited external examination immediately after his death, which revealed no evidence of violence. Many years later a partial forensic examination was performed.

Who was the patient?

  1. Beethoven

  2. Jerry Garcia

  3. Gershwin

  4. Toscanini

  5. Mozart

View the correct answer.

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