The term is rooted in scriptures such as Revelation 12:9 , which describes the "great dragon... called the Devil, and , which deceiveth the whole world".

A 2023 report in the Journal of the American College of Chest Physicians titled "Disseminated Blastomycosis: The Great Deceiver" details a case of a fungal infection that presented with symptoms easily mistaken for other pulmonary issues, illustrating why clinicians use this nickname for the disease.

The phrase is also used as a metaphor for diseases or biological elements that are difficult to diagnose because they mimic other conditions.