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Jan V. Hirschmann, MD; Peter Richardson, PhD; Ross S. Kraemer, PhD; Philip A. Mackowiak, MD, MBA

Arch Intern Med. 2004;164:833-839.

A 69-year-old Judean man presents with chronic low-grade fever, pedal edema, and abdominal pain. His condition deteriorates over several weeks with the appearance of shortness and foulness of breath, pruritus, convulsions of every limb, and gangrene of the genitalia. Just before he dies, he orders dozens of the leading men of his kingdom imprisoned and instructs his sister to kill them all after he is gone. Who is he and what is the likely cause of his death?

From the Medical Service, Puget Sound Veterans Affairs Health Care System and the University of Washington School of Medicine, Seattle (Dr Hirschmann); the Centre for the Study of Religion, University of Toronto, Toronto, Ontario (Dr Richardson); the Department of Religious Studies, Brown University, Providence, RI (Dr Kraemer); and the Medical Care Clinical Center, Veterans Affairs Maryland Health Care System and the University of Maryland School of Medicine, Baltimore (Dr Mackowiak). The authors have no relevant financial interest in this article.

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