The Case of the Affluent Artist With Rapidly Deteriorating Vision

Albert Lowenfels, MD; Patrick Maisonneuve, Eng

Disclosures

August 10, 2010

The Case

A 66-year-old prominent artist noted diminished vision in the left eye, which progressed within 10 weeks to complete loss of vision in the afflicted eye. Over the next 24 months, other symptoms in the left eye developed, including pain, swelling, and bloody appearance of the cornea. Because of his visual loss, he was no longer able to paint, and he became anorexic and had increasing bouts of depression. The patient received minimal medical attention for his deteriorating health until a month before his death, when he was examined and found to have an enormously enlarged liver. During the last few months of his life, the patient became progressively weaker, until he was finally unable to get out of bed. He died peacefully about 2.5 years after the first onset of visual symptoms.

Medical History

At age 11 years, the patient had developed small pox. At age 26 years, he had an attack of otitis that resulted in a partial hearing impairment. When he was 59 years old, he had had a stroke but recovered sufficiently to resume his painting. He also had a permanent facial scar from a horseback fall when he was a teenager.

Autopsy Findings

The day after the artist's death, John Hunter, the leading surgeon of the time and whose portrait had been painted by the patient (Figure 1), performed the autopsy.

Figure 1. John Hunter, the foremost surgeon of his era, as painted by the artist in 1785 and engraved by William Sharp. The portrait includes part of the skeleton of the Irish Giant, a prominent object in Hunter's private medical museum. From http://www.gutenberg.org/files/22574/22574-h/22574-h.htm

Main findings included a slight adhesion of the left lung to the chest wall. Abdominal findings were normal except for the liver, which was pale; a yellow color; and twice its normal size, weighing 11 lb (24 kg). Hunter did not examine the left eye but reported the optic nerve on the right side as "shrunken."[1]

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