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Herod the Great and Polyarteritis Nodosa—Reply
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In reply
These letters propose interesting alternative diagnoses for Herod’s illness. Hepatic schistosomiasis occurs when the fluke’s eggs lodge in portal venules, causing granulomatous inflammation, fibrosis, and presinusoidal portal hypertension. The most evident clinical consequences are hepatosplenomegaly, sometimes visible as abdomen fullness, and gastrointestinal hemorrhage from varices.1 Josephus does not mention these features. Since significant cholestasis is absent, pruritus does not occur. Unless other diseases coexist, hepatocellular function remains fairly normal, and hepatic encephalopathy seldom develops. Schistosomiasis, therefore, could not readily explain itching or mental changes.
The correspondents suggest that Herod had platypnea caused by intrapulmonary vascular dilatations associated with liver disease (hepatopulmonary syndrome). Josephus describes Herod’s breathing problem in The Jewish War (Book I: Paragraph 656)2 with the word "orthopnea" in Greek, which means he could breathe comfortably only when upright. The passage in Jewish Antiquities (Book 17: Paragraph 169)3 is more difficult and can be translated as "a . . . [Full Text of this Article]
AUTHOR INFORMATION
Jan V. Hirschmann, MD;
Peter Richardson, PhD;
Ross S. Kraemer, PhD;
Philip A. Mackowiak, MD, MBA
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