Beethoven's triad: Diarrhoea, deafness and cirrhosis. A plausible solution to the 195-year-old controversy.

Beethoven suffered from episodes of severe diarrhoea starting in his late teens, and increasing deafness from around the age of 28. He died from cirrhosis of the liver at the age of 57 in 1827. The nature of his diseases has been controversial ever since. Until recently, no one has invoked a single disease that would explain the chronic afflictions of his bowel, ears and liver. Suggested diagnoses have included lead poisoning, alcoholic cirrhosis, viral hepatitis, inflammatory eye disease, rheumatism, inflammatory bowel disease, Paget's disease of bone, Cogan's syndrome, systemic lupus erythematosus, otosclerosis, chronic pancreatitis, tuberculosis, sarcoidosis, Whipple's disease, renal papillary necrosis and syphilis. In 2005, Karmody and Bachor suggested that Beethoven suffered from chronic ulcerative colitis and its sequels. It is now known that ulcerative colitis may be complicated by sensorneural deafness and sclerosing cholangitis which progresses to cirrhosis, liver failure and death. These apparently diverse diseases are now believed to share an autoimmune pathogenesis. This explanation neatly joins together Beethoven's triad of diarrhoea, deafness and cirrhosis.