The Case of the Ruthless Ruler With a Deadly Disease

Albert B. Lowenfels, MD; Patrick Maisonneuve, Eng

Disclosures

May 19, 2008

Introduction

The patient was an elderly male, a member of a prominent royal family, who became a ruthless ruler of a European principality. Little is known about his medical background, family history, or details about his final illness except that he was obese and a nonsmoker. From what is now known about his cause of death, it is likely that disturbing symptoms would have appeared several months before his terminal illness and would have included abdominal pain, constipation accompanied by vomiting, and weight loss. He probably would have noted blood in his stool. He did not undergo any diagnostic procedures nor did he undergo any operations. During his reign, he was feared as a ruthless but energetic king, ruling over a large geographic area. He survived several life-threatening attacks by conspirators. There may also have been attempts to poison him. To the great relief of his subjects, he died at age 63 after ruling for 36 years. Several hundred years after his death, the patient's body was exhumed so that an autopsy could be performed. It revealed a definitive pathologic diagnosis for his final illness.

What diagnosis do you think best explains the presumed symptoms?

  1. Biliary tract cancer

  2. Diverticulitis

  3. Poisoning

  4. Abdominal aneurysm

  5. Colorectal cancer

View the correct answer.

Who was the patient?

  1. Alexander the Great

  2. Ferdinand I of Naples

  3. Peter the Great

  4. Napoleon

View the correct answer.

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