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I. Introduction
With a heavy heart, the Maesters of the Citadel and yours truly, a humble dermatologist, must sadly announce the passing of King Viserys I of House Targaryen, First of His Name, King of the Andals, and the Rhoynar and the First Men (and let's not forget, the King of Awkward Skin Conditions). The beloved King had been suffering from a debilitating skin disease for the past 20 years of his reign, and despite valiant efforts to treat it, the condition ultimately proved fatal.
II. Presenting complaints
King Viserys presented with various symptoms, including skin lesions, open sores, rotting of the flesh, drinking, dementia, bureaucratic migraine, and disappointment in his brother.
III. Symptoms
On initial clinical examination, the King had purulent exudates and necrotic tissue on the back, which were thought to be caused by sitting on the Iron Throne for prolonged periods. However, as the disease progressed, it manifested in further symptoms such as recurrent bouts of cough and putrefaction of the flesh, particularly on the King's hand. It even resulted in the use of maggots for debridement.
IV. Diagnosis
A presumptive clinical diagnosis of leprosy was made by examining and observing the King's symptoms, considering the limited diagnostic means available in medieval Westeros. Differential diagnoses considered included pyoderma gangrenosum and necrotizing fasciitis.
V. Treatment and Outcome
Treatment for the King's illness was extensive and included leeches, maggots, herbal teas, and cauterization prescribed by the Grand Maester Mellos. Despite the efforts made by the Citadel maesters to preserve his limbs, King Viserys gradually lost two of his fingers, then the lower portion of his left arm, and eventually his right eye, resulting in a rather distinctive pirate-like appearance.
As the disease progressed, King Viserys developed severe facial necrosis, leading to necrotic tissue loss and mutilation of maxillary tissue. Unfortunately, the patient succumbed to his illness, which proved progressive and ultimately fatal.
His legacy lives on through his loving wife and their little dragon-children, who will probably all roast each other at any moment in true Targaryen fashion.
VI. Discussion
Leprosy (Hansen's disease) holds great historical significance and is one of the oldest known diseases. The earliest evidence of leprosy dates back to ancient civilizations such as Egypt and India, with descriptions of the disease appearing in texts dating as far back as 600 BCE.
Leprosy is caused by the acid-fast bacillus (AFB) Mycobacterium leprae, which is known to have a slow growth rate, leading to the chronic progression of the disease. The infection primarily affects the skin, nerves, and mucous membranes, leading to characteristic clinical signs such as skin lesions, nerve damage, and muscle weakness.
The disease is transmitted through respiratory droplets, though other potential modes of transmission include contact with contaminated clothing, objects, or even conjugal contact.
Diagnosis of leprosy is typically made through a combination of clinical examination and laboratory testing, including skin smears and biopsies for AFB. Treatment for the disease involves using a variety of antibiotics, with the most commonly used regimen being a combination of dapsone, rifampin, and clofazimine.
The disease remains a public health concern in certain parts of the world, particularly in regions with poor access to healthcare. The World Health Organization estimates that there were approximately 127,558 new cases of leprosy reported in 2020, highlighting the ongoing need for increased awareness and efforts to combat the disease.
King Viserys' chronic illness can be attributed to a few factors. Firstly, the slow growth rate of Mycobacterium leprae (between 1 to 5 years) allows the disease to progress over a long period. Secondly, the fact that M. leprae primarily infects peripheral nerves, resulting in nerve damage and loss of sensation, which can lead to delays in detection and treatment. And lastly, the medieval healthcare system in Westeros was not advanced enough to properly diagnose and treat the disease, leading to the King's suffering for 20 years. All in all, King Viserys' leprosy was a real drag.
VII. Conclusion
As we bid farewell to the late King, we remind our readers that leprosy, though rare, is a severe condition and urge prompt medical attention if symptoms similar to King Viserys' are observed. And remember, always keep a healthy distance from the Iron Throne. It's not just a seat; it's a trap!
Cite: Mohta A, Citadel Maesters. The Tragic Medical Chronicles of King Viserys I: A Case Report. Limitless Skin by Dr Alpana. 2023;1:1.
Note: The above case report is just a fictional, humorous take on the given story from the television series "House of the Dragon" and should not be taken as a serious medical case report. This report does not intend to hurt any sentiments or offend anyone. Sources:
Viserys I Targaryen. Game of Thrones Wiki.
Leprosy. World Health Organization. 2022.