How did King Aegon IV actually die?

[Maegor_the_Cool]

The reign of the unworthy monarch finally ended in early 184 AC. At only forty-nine years of age, he had become so morbidly obese he could not walk anymore, making many wonder how his last mistress could endure his embrace. Aegon died a horrible death, his bloated body so swollen that he could not even lift himself from his couch that became covered in his feces. Aegon's limbs were rotting and crawling in hosts of flesh worms, and the maesters said they had never seen the like of this before. The septons, however, pronounced it a judgment of the gods. He was given the milk of the poppy to try to dull the pain but nothing else could be done.

Aegon's last decree before his death was bitter poison that would lay the seeds to generations of war, bloodshed, death, and woe to the realm. Aegon legitimized all his bastard children, causing five generations of strife as the Blackfyre Pretenders tried to claim the Iron Throne.

[Frey family reunion]

53 minutes ago, Jon Snowfyre said:

The reign of the unworthy monarch finally ended in early 184 AC. At only forty-nine years of age, he had become so morbidly obese he could not walk anymore, making many wonder how his last mistress could endure his embrace. Aegon died a horrible death, his bloated body so swollen that he could not even lift himself from his couch that became covered in his feces. Aegon's limbs were rotting and crawling in hosts of flesh worms, and the maesters said they had never seen the like of this before. The septons, however, pronounced it a judgment of the gods. He was given the milk of the poppy to try to dull the pain but nothing else could be done.

Aegon's last decree before his death was bitter poison that would lay the seeds to generations of war, bloodshed, death, and woe to the realm. Aegon legitimized all his bastard children, causing five generations of strife as the Blackfyre Pretenders tried to claim the Iron Throne.

Could be limb infarction caused by untreated diabetes.

[Alester Florent]

41 minutes ago, Frey family reunion said:

Could be limb infarction caused by untreated diabetes.

Diabetes was my first thought too.

[Loose Bolt]

Another possibility is very nasty STD.

[Walda]

George IV (aka the Prince Regent, Prince of Whales, Alvanley's fat friend) had diabetes, which was regarded as a type of gout at the time.

In addition, Aegon might have had pressure sores. These start with poor circulation and pressure to an area. It is too easy to leave a small pressure area untreated or inadequately treated in very large immobile patients due to the difficulty moving them, without tearing their softer, moister, more fragile skin or exacerbating the injuries already there. The large surface area of their bodies need to be checked and massaged and cleaned very regularily (at least every 2 hours, including all through the night), especially the numerous deep skin folds, that tend to chafe and get sweaty and have skin flakes - it is quite difficult and time consuming to make sure all of these don't develop cracks that could become infected.

Just cleaning his bottom properly would be a challenge, and that combined with pressure sores would explain the maggots. Terribly painful, even without the maggots. I hope he was stuck on a well padded couch with silk sheets to roll him on, rather than one with springs that dig into him like the swords of the Iron Throne.

But I always thought GRRM was hinting that Aegon IV had contracted Sweetrot from a sex partner, leaving it to the reader to determine how a disease from Sotheryos had found its way to the Iron Throne.

Edited August 5, 2023 by Walda

[KingAerys_II]

Worms ate him alive, I don't know if it is a disease, but it is a sign George RR Martin doesn't like the Unworthy 

[Gilbert Green]

Cursed by the gods.  For unworthiness.

[Lord Varys]

Since that is a fantasy series it might be a hint he was cursed by somebody he shouldn't have crossed.