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comikadraws · 1 month ago

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What actually was Itachi's desease? Does anyone know?

I AM GETTING ITACHI ASKS! FINALLY!!! Though I imagine my answer might be disappointing :')

Itachi's Mysterious Illness

Length: • 3.2K Content: • Itachi's Illness as a Writing Tool • Itachi's Symptoms • Popular Diagnoses • Exploring Alternative Causes • My Thoughts and Theories

DISCLAIMER: I have no medical background and, for the most part, am relaying the findings of others, not my own. Some of the panels are out of order. Blue links are sources. The art in the header is mine.

Itachi's Illness as a Writing Tool

Itachi's illness is very much a mystery in canon. A side-note. Itachi doesn't make enough appearances in the story for us to get an elaborate picture of his health. While there are popular theories, the fact of the matter is, we just don't know for sure what he was suffering from.

Due to Itachi's illness not playing a larger role in the story, it is unlikely Kishimoto actually researched any particular disease to reference. He resorted to a fairly common trope called the "Incurable Cough of Death" which is known for taking inspiration from Tuberculosis and its bloody coughs. The author doesn't specify any illness. It is merely a plot device to push a storyline.

As a narrative device, you might even consider Itachi's illness as a metaphor. While dying young was a deliberate choice on Itachi's part, his illness further solidifies his decision, leaving him with no way back. It mirrors Itachi's lack of agency in life. And, of course, it also makes Itachi's suffering palpable and highlights it for the audience. Itachi is in agony, yet chooses to suffer for Sasuke's sake rather than taking the easy way out.

Of course, while Itachi's illness is an unspecified, plot- and/or narrative-device disease, that doesn't necessarily have to stop us from trying to find a real-world equivalent or an in-universe explanation. But to do so, we must describe his physical condition first.

Itachi's Symptoms

While hemoptysis is probably the trademark of Itachi's illness as portrayed in fandom, it can be argued he was experiencing a wider range of symptoms. None of these necessarily have to be the result of Itachi's illness but since they often come up in discussions, I will mention them anyway for the sake of completion.

Low BMI

To begin with, Itachi's body is in a fairly weak condition. For example, Itachi's BMI stands fairly low at 18.3 at the time of his death, which is considered to be slightly underweight. It is a slight drop from his 18.6 at 18 years old.

While BMI is not a professional way of measuring a person's health, it does bring things into perspective. Considering that Itachi is a physically active person, he probably had a low fat-to-muscle ratio. Combine that with his low BMI and we can fairly assume that Itachi had weight problems, assuming Kishimoto and/or his assistants put that much thought into those numbers.

Low Stamina According to Databooks

Itachi's stats in the Databooks also indicate somewhat of a physical weakness. While Itachi ties with Jiraiya in having the highest stat total in Sha no Sho (35.5 points), he has noticeably low stamina at a value of just 2.5 points. It is not a major deficit, but it is definitely odd, especially when putting things into perspective.

In the Databooks, characters with high stat totals usually have stat deficits at 3 or 3.5 points, not at 2.5. Stat deficits of 2.5 occur at slightly lower stat totals, like Might Guy who reaches a stat total of 31.5 and a hand seal deficit of 2.5.

Additionally, characters with stamina deficits are usually associated with physical ailments. Orochimaru is basically suffering from necrosis, Hiruzen is 70 (his old age likely impacting his physical prowess), and Kakashi basically goes unconscious every time he uses the Sharingan as early on as chapter 16 of Naruto (indicating low chakra reserves).

Again, we better hope those numbers were intentional or this doesn't mean anything.

Noticeable Frailty

But now, let's take a look at the manga to search for evidence. What other fans before me have already pointed out is that Itachi's interactions with Kisame are fairly curious.

In a seemingly random scene, Kisame worries about the weather, claiming both he and Itachi will catch a cold if they stay out in the rain for too long. It is a somewhat strange suggestion, considering that this is coming from a shark man who primarily uses water ninjutsu in his battle tactics. You'd think he isn't bothered by some rain or chill if he is already getting wet this often.

Not that this applies to his partner, however.

In chapter #364 we get a repeat of this scene in which Kisame expresses worry only for Itachi rather than for the both of them. Kisame is made out to be explicitly caring toward Itachi and sensitive to his health and needs. But looking back at chapter #353, he refrains from hurting Itachi's pride by stating it out in the open.

This recontextualizes the scene from a few chapters earlier as this pattern in Kisame's behavior is actually consistent with the rest of chapter #353.

Kisame mentions that Itachi was absent from his most recent battle against Roshi. For unknown reasons, this causes Itachi's expression to turn somber or melancholic (though it could be argued he is smirking ever so slightly). Perhaps Itachi was reminded of his physical decline. Perhaps he regrets missing out on this last mission with Kisame.

Either way, Kisame picks up on Itachi's mood and quickly clarifies that this solo battle was the former Kiri-nin's idea and not at all Itachi's fault. While we cannot say for sure, the possibility that Kisame insisted on going without Itachi specifically to spare the Uchiha from putting unnecessary strain on his body is definitely there.

Kisame goes on to say he is tired, yet the first person to sit down in search of a break is Itachi - The same guy who didn't even fight Roshi and, at least technically, should be in better health than Kisame.

Kisame's worry for Itachi's health supports the idea that Itachi has been struggling for a while now - long enough for Kisame to pick up on Itachi's condition. He watches out for any strain or health risks that Itachi might unwittingly subject his body to, implying certain frailty that could be explained by a weak immune system and/or a weak and easily fatigued body.

During the Battle (Hemoptysis, Vision Loss, Heart Attack)

Besides this, Zetsu comments on Itachi's condition multiple times - both during and after the brothers' battle. He mentions that Itachi's movements were sloppy and wonders why he was coughing up blood. He hypothesizes that Itachi's body may have already been pre-damaged at that point.

Guessing by Zetsu's reaction, this must have been a recent decrease in Itachi's battle performance rather than a long-established issue. Combining this with Kisame's behavior (that instead implies a longer history) Itachi's condition has likely been bad for a longer time but never impacted him this severely until now. The illness may have just worsened naturally, but Itachi could've also stopped medicating or caught an additional infection.

During the actual battle, we see Itachi struggling with several more symptoms. He suffers from vision loss as well as from hemoptysis (bloody coughing) and what appears to be a heart attack or otherwise intense chest pain.

After the end of the battle, White Zetsu also theorizes that Itachi's symptoms may have simply been caused by the Sharingan, only for Black Zetsu to voice his uncertainty. An odd reaction, considering that Zetsu is one of the few characters that should be fairly knowledgeable about the Sharingan and its drawbacks. This implies that Itachi's symptoms are atypical of your usual Sharingan overuse.

Medication

Obito later explains that Itachi's illness was terminal and demanded regular medication to prolong the patient's lifespan. Obito unfortunately does not comment on the origins of Itachi's illness or any of his symptoms, though.

While not necessarily canon, in "Naruto Jinraiden: The Day the Wolf Howled", Itachi uses a drug called "Kotaro", which uses hallucinogenic substances. It is applied via the eyes and also helps with irritation of the Mangekyo Sharingan.

Popular Diagnoses

Once again, Itachi's symptoms are rather vague, befitting the Cough of Death trope. But some people have still managed to find likely candidates for real-world equivalents.

One such candidate is obviously Tuberculosis. It matches some of Itachi's symptoms, such as his coughing up blood, chest pain, weight loss, and tiredness. Another Tumblr user pointed out, however, that Tuberculosis is highly infectious. Had Itachi contracted the disease, other Akatsuki members would've fallen ill as well, not to mention Sasuke who came into contact with Itachi's blood and was supposed to inherit his eyes. This would've been beyond careless of Itachi. Any infectious, terminal diseases can therefore be safely ruled out.

The same user argued that Itachi may have had Lupus or ITP, both of which are immunological and therefore better suited for Itachi's diagnosis. It should be noted, however, that Itachi does not express many symptoms associated with Lupus, such as joint swelling, rashes, and skin lesions, and ITP is not particularly known (if at all) for hemoptysis.

The most popular theory is probably that Itachi had MPA. It is known for bloody coughs, cardiac failure, fatigue, weight loss, and in rare cases it may damage the eyes. But there are also people who disagree with the MPA theory, mostly due to his young age (which is atypical for MPA patients), but also because MPA causes diffuse alveolar hemorrhage, which the original poster deems more severe than just hemoptysis. While Itachi's symptoms match MPA somewhat, it might not be a perfect match.

But Itachi could have also died of lung cancer, Sarcoidosis, AIDS, SLD, Viral Perimyocarditis, Pneumonia, Paragonomiasis, Lymphoma, or something entirely different, due to the vagueness of his symptoms. But since we are talking about a fictional universe, it could also be a fictional disease or even a disease that attacks fictional parts of ninjas' anatomy (such as Tenketsu, Chakra Pathways, etc.).

And while I do like the idea of Itachi just being hated by life itself (vocaloid reference, haha) and developing a terminal condition on top of all his other sufferings, I could also see it being a manifestation of his guilt and trauma rather than just simply being an unrelated burden the universe put on him. Heartbreak Syndrome, basically.

Exploring Alternative Causes

Another way to explain Itachi's symptoms is by finding alternative causes. Believe it or not, but it is not 100% certain that Itachi had a disease in the traditional sense at all.

Obito Is a Liar

One of the reasons why is that Obito, unfortunately, is a liar. Especially in his conversation with Sasuke, his goal is to make Itachi as sympathetic to Sasuke as possible and demonize Konoha. Both are in an attempt to win over Sasuke's loyalty and Obito is not at all afraid of lying to Sasuke.

This is hinted at in the Databooks but also becomes evident in certain instances where Obito's exposition simply proves wrong - most notably the cause behind the Ninetails Attack. Obito's words directly clash with Itachi's and later Kushina's flashbacks.

Not to mention, Black Zetsu appears noticeably confused about Itachi's condition, leaving us to question how Obito acquired this much information on Itachi in the first place, if not through the Akatsuki's spy. Is Obito really this knowledgeable about Itachi? Would Itachi's condition really have been terminal? Did Itachi have his condition treated with medicine? Or is it all just a shot in the dark on Obito's part?

Long story short, we cannot trust Obito's word when making any claims about canon.

But now, let's find the promised alternative explanations.

Itachi's BMI Is a Lifestyle

To begin with, most of the Akatsuki members actually have low BMIs. Obviously, Nagato is severely underweight, but even characters like Sasori and Hidan score quite low. The average among the Akatsuki appears to be at 17.8 (or 18.2 if we exclude outliers like Nagato, Konan, and Kisame). This might reflect the Akatsukis' precarious living conditions or just the standard Ninja physique, rather than indicating any specific ailments among the Akatsuki members.

Of course, Kisame still manages to somehow reach a healthy BMI, but this might be the result of their respective diets rather than Itachi just magically losing weight. While Itachi dislikes steak (which has high calories and protein) he eats less nutritious foods like onigiri with seaweed, dango, and cabbage. Meanwhile, Kisame loves shrimp and crab (which are high in protein). And beyond that, Itachi could be suffering from mental illness instead, impacting his eating habits.

It should also be noted that low BMIs (as well as stress and trauma) can weaken the body's immune system and impair its ability to fight off common infections.

No Training, No Stamina

As previously mentioned, while Itachi's low stamina is highly unusual among characters of comparable caliber, it is just a small difference of 0.5 points. It might merely be the result of his fighting style which relies primarily on genjutsu or quick and painless assassinations rather than physically taxing maneuvers. This would be similar to Might Guy, who has a 2.5 deficit in hand seals due to a lack of practice.

But this explanation still begins to sound less sufficient when we look back at the manga itself. Itachi's interactions with Kisame in chapters #353 and #364 imply a certain frailty beyond just a simple lack of practice. But this is where Itachi's Sharingan becomes relevant.

Mangekyo and Susano'o Side Effects

Many fans underestimate the damage a Mangekyo Sharingan can inflict on its user. Most notably, the Mangekyo causes the user's eye to bleed and become irritated. Their eyesight deteriorates with repeated use until full blindness. (refer back to chapter #386). Those are not symptoms specific to Itachi at all and can therefore not exactly be traced back to any disease.

Additionally, the Mangekyo does not just affect the user's eyes. In the case of Susano'o specifically, it is stated to be hard on the user's body. Sasuke describes it as an unbearable pain affecting every cell in his body. And to top it off, it causes hemoptysis for Sasuke as well each time the Susano'o is in use.

It appears as though hemoptysis is not at all exclusive to Itachi but a Susano'o-specific symptom. It doesn't change that Zetsu remains puzzled about Itachi's bloody cough, so we have to assume Zetsu might just not be as much of an expert as previously assumed.

Assuming Itachi had already used the Susano'o at a point in time prior to his battle with Sasuke, it is possible that this jutsu has damaged Itachi's cells.

Since we know that the body's cells are partially responsible for chakra production, cell damage should logically impact a ninja's ability to produce chakra. Assuming Susano'o-conducted damage is at all permanent and that Itachi has ever used it prior to his battle with Sasuke, this may have caused an irreversible chakra shortage for Itachi.

Sharingan Side Effects and Chakra Depletion

In general, besides the Susano'o, the Mangekyo is known for wearing out its users. Not just Kakashi, who famously ends up in the hospital each time he uses it, but Itachi too requires long rests after using the Mangekyo. Notably, Kisame describes using the Mangekyo as "dangerous".

Even the standard Sharingan can deplete the user's chakra to the point of being immobilized. As we can see in early Naruto chapters, the Sharingan can put Kakashi out of commission for a weak (refer to chapter #16). It appears as though chakra exhaustion causes muscle weakness (inability to move) and fatigue.

While not as extreme, this would explain Itachi's fatigue in his interaction with Kisame in chapter #353. In this chapter, we can see that Itachi's Sharingan has remained active for an unknown period of time and likely robbed Itachi of a portion of his chakra. If this is something he did regularly, it might also explain Kisame's concern for Itachi.

If we think about this one further, it could be argued that the heart, due to being a muscle, can fail in the case of excessive chakra exhaustion.

My Thoughts and Theories

Itachi's vision loss and hemoptysis can clearly be attributed to his excessive Mangekyo and Susano'o use, as far as I am concerned. And right now, all of Itachi's symptoms can be logically explained without adding an unknown disease into the mix.

Although Zetsu still remains an unreliable source in this instance (due to not knowing that hemoptysis is a common symptom induced in response to using Susano'o) it should be noted that unlike with Itachi, this does not result in a lethal outcome for Sasuke who, as opposed to Itachi, uses his Susano'o constantly. When hypothesizing that Itachi's body may have been damaged from the beginning, he probably wasn't far off. This is also what Itachi's interactions with Kisame seem to imply.

While Itachi's Mangekyo use and chakra exhaustion probably put the final nail in his coffin, it stands to reason that his body was prestressed by yet another condition that shrunk down his chakra reserves and left him, in Kisame's eyes, "frail". It's comparable to how many diseases such as AIDS, Diabetes, autoimmune diseases, or other conditions don't kill you on their own but instead lay the groundwork for a truly lethal illness.

But even then, this pre-sustained damage has logical explanations as well. His low fat could be the result of his lifestyle. His low stamina and chakra may be the result of repeated Sharingan/Susano'o use or a lack of practice. His heart attack may have been the result of ordinary chakra exhaustion. His immune system may have been weakened due to his low weight (but then again, he is not significantly underweight), stress, and/or trauma, resulting in the contraction of a regular infection as Itachi stood in the rain without protection. This explains his seemingly "sudden" decrease in battle performance.

Conversely, it is not unreasonable to assume Itachi indeed had an incurable condition - unrelated to Sharingan's drawbacks. While Obito and Zetsu are not at all reliable sources, they do push the "Itachi was ill" narrative rather hard and the story never cares enough to dispel their claims.

Beyond that, Itachi's symptoms can be viewed as a causality dilemma. What was first? The chicken or the egg? The immune system or the illness? While low weight, stress, and/or trauma can result in frequent infections, so can a major infection lead to increased stress or low weight. While blaming Itachi's poor condition on his lifestyle is a valid interpretation, it is not at all confirmed.

Narratively, it makes a lot of sense to burden Itachi with a painful, incurable disease. Aside from externalizing Itachi's suffering to the outside, where the audience can see it, it manages to evoke stronger sympathy from the reader, mixing in a sense of unfairness and tragedy.

But alas, this is not sufficient evidence, and instead, we could also view Itachi's damaged condition as a metaphor for how very often, life does not leave Itachi with any options other than harming himself. Due to his growing blindness, he is forced to use his Sharingan more frequently. Due to his status as Nukenin, he cannot take care of himself as diligently. And then those minor inconveniences spiral out of control, piling ailment after ailment on him.

Unfortunately, none of this leaves us with a definitive answer. Perhaps Itachi did have a terminal illness. Perhaps he did not. The story seems intentionally ambiguous.

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