How Tutankhamun might have died

King Tutankhamun’s death, which occurred when he was about 19 years old, has fascinated Egyptologists for decades, particularly since the rediscovery of his remains and tomb in 1922.

Over the years, many scholars have offered a wide variety of explanations for his early demise as well as for the seemingly androgynous appearance of his face and gynaecomastia portrayed in sculptures and other relics.

These diagnoses have included Marfan syndrome (a genetic disorder of the connective tissue), Wilson-Turner X-linked mental retardation syndrome, Fröhlich syndrome (a rare metabolic syndrome characterised by growth retardation and retarded development of the genital organs), Klinefelter syndrome (in which men have an additional X chromosome in most of their cells) and Antley Bixler syndrome (a rare congenital disorder associated with skeletal malformation) — in addition to murder and infectious disease.

However, an Egyptian study (published in JAMA in February 2010), which used genetic testing and computed tomography scans to examine mummies from Tutankhamun’s family lineage, found no evidence of these syndromes or of gynaecomastia. What it did find, though, was an accumulation of malformations in his family, with evidence of Kohler disease II (a rare bone disorder of the foot found in children) in Tutankhamun himself.

Moreover, genetic testing for genes specific to Plasmodium falciparum found evidence of malaria in four of the studied mummies, including the king’s.

The researchers therefore suggest that bone necrosis, resulting in weakened bones and difficulty in walking, along with malaria, was the most likely cause of Tutankhamun’s death. Moreover, the idea that Tutankhamun suffered problems in walking and malaria is supported by the discovery of canes and an “afterlife” pharmacy in his tomb, the researchers said.

However, a team from the Bernard Nocht Institute in Hamburg has questioned the conclusions of this study in a letter to JAMA. Although the Hamburg researchers agree that the gene fragments identified in the mummy may prove the presence of P falciparum, they are not convinced that malaria was the cause of Tutankhamun’s early death.

They say that in endemic areas, malaria is a life-threatening disease commonly affecting children until the age of six to nine years, not adults of 18 to19 years, who would be semi-immune.

In contrast, they highlight a figure included in the Egyptian study that, in their view, suggests radiological signs compatible with the osteopathological lesions seen in sickle cell disease, a genetic blood disorder that is carried by 9–22 per cent of inhabitants of Egyptian oases, according to the Hamburg team.

Sickle cell disease causes blood cells to become rigid and crescent-shaped, thereby blocking capillary blood flow and leading to chronic pain and tissue death. A single copy of the sickle cell gene confers increased immunity to malaria so it tends to be common in areas where the disease is endemic. Despite this increased immunity to malaria, people with sickle cell disease can still carry P falciparum in their blood.

According to the Hamburg team, such an infection could have triggered a fatal sickle cell crisis in which Tutankhamun’s organs were starved of oxygen. The researchers called for further DNA tests on Tutankhamun’s mummy to provide more evidence relating to his death.