The Case of the Soldier-Statesman With a Bloated Belly

Albert B. Lowenfels, MD


March 08, 2012

The Diagnosis


Although an autopsy was not performed, alcoholic cirrhosis seems to be the most likely diagnosis. The patient had a history of heavy drinking, beginning as an adult and continuing until he lapsed into coma. Palmar erythema, along with spider telangiectasia, is commonly observed in cirrhosis.[1] Most patients who develop alcoholic cirrhosis consume 5 or more drinks on a daily basis for 20 or more years. Our patient fits into this consumption pattern, and he usually drank raki, a strong local brandy. We have no information about the patient's nutritional status, but malnutrition is more common in alcoholics than in the general population and is another cofactor that is often present.

There are still many unsolved mysteries concerning alcoholic cirrhosis. For example, why do less than 20% of heavy drinkers develop cirrhosis? And why do some heavy drinkers develop cirrhosis, but others develop chronic pancreatitis? There is likely to be a genetic component to the disease, because monozygotic twins are more susceptible than dizygotic twins.[2]

Other Alcohol-Related Illnesses

Alcoholism can be described as equal-opportunity disease because it affects both men and women, persons of all races, and residents of all countries. Although for most individuals, consuming alcohol is a safe, enjoyable experience, about 10% of all consumers drink heavily or become addicted to alcohol.

Fame does not provide immunity from the serious consequences associated with heavy consumption of alcohol. The Table below shows a selected list of 10 famous persons, including writers, soldiers, musicians, and leaders, who died of alcoholic cirrhosis or other alcohol-related disease. The lifespan of these talented individuals is well below that of persons without cirrhosis or alcohol-related illness.

Table. Selected List of Prominent Persons Who Died of Alcoholic Cirrhosis or Alcoholism

Name Profession Age at Death
Alexander the Great Soldier 32
Truman Capote Writer 59
F. Scott Fitzgerald Writer 44
O. Henry Writer 47
Mickey Mantlea Hall of Fame baseball player 63
Jim Morrison Musician/singer 27
Charlie Parker Musician 34
Franklin Pierce US President 64
Edgar Allan Poe Writer 40
Dylan Thomas Writer 39

aDied 2 months after liver transplant in 1995.

The Patient


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