CHEST Guidelines-Pulmonary-Echinococcosis-in-the-Terminal-Disease-o (1)

Pulmonary-Echinococcosis-in-the-Terminal-Disease-o (1)

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The article discusses the terminal illness and cause of death of Ferdinando II de’ Medici, the Grand Duke of Tuscany (1610-1670). His death was historically attributed to an "ictus following dropsy" or more specifically, to disseminated cystic echinococcosis caused by the parasite Echinococcus multilocularis. However, E. multilocularis, a more aggressive form of the parasite found in Northern Europe, was unlikely to be present in the Mediterranean region. Instead, E. granulosus, causing a milder form of the disease known as hydatid disease, was prevalent in Italy.<br /><br />During his final months, Ferdinando II suffered severe respiratory issues, and despite treatment by his court physicians, his condition deteriorated. He experienced a right-sided cerebrovascular accident (stroke), and later died after a massive increase in respiratory distress. An autopsy revealed significant hydatid disease affecting the right lung and pleura, consistent with infection by E. granulosus. The heart was found to contain a large “polyp,” most likely a thrombus which might have caused the embolism leading to the stroke.<br /><br />The findings indicate that the direct cause of Ferdinando II's death was the stroke resulting from an embolic infarction of the right cerebral hemisphere. The stroke was probably due to an embolus originating from the heart, possibly exacerbated by the echinococcosis affecting the heart's base. Despite the less severe nature of E. granulosus, the complications it created contributed to the final fatal stroke. This documented medical history offers insights into historical diagnoses and the health circumstances of Ferdinando II’s time.

Keywords

Ferdinando II de’ Medici

Grand Duke of Tuscany

terminal illness

cause of death

cystic echinococcosis

Echinococcus granulosus

hydatid disease

stroke

embolism

historical diagnoses