Bertolt Brecht. Did he really have rheumatic fever?

• Published in: Zeitschrift für Rheumatologie 2020-12, Vol.79 (10), p.1050-1056
• Main Author: Zeidler, H
• Format: Article
• Language: ger
• Subjects: Adolescent; Brecht; Chorea - diagnosis; Diagnosis, Differential; History, 19th Century; History, 20th Century; Humans; Male; Retrospective Studies; Rheumatic Fever - diagnosis; Rheumatic Heart Disease - diagnosis; Rheumatology - history
• ISSN: 1435-1250
• DOI: 10.1007/s00393-020-00846-8

The writer Bertolt Brecht (1898-1956) is known for his poems, dramas and the "epic or dialectical theater" he founded. He was retrospectively postulated to have had rheumatic fever because of heart problems and neuromuscular symptoms in his youth. Based on current rheumatological knowledge, it cannot be deduced with certainty from the available documents that Brecht had rheumatic fever. At most, a very unusual manifestation of rheumatic fever can be suspected with atypical rheumatic chorea and a very atypical course of rheumatic carditis. Several deviations from the classical clinical picture-the absence of fever and arthritis, no typical symptoms of Sydenham's chorea, the lack of a diagnosis of heart valve defects in adolescence-lead to extensive differential diagnostic considerations. A possible psychosomatic origin through functional heart complaints must even be postulated if a temporary previous organic cause cannot be excluded. Only the use of the advanced diagnostics available today with Doppler sonography of the heart, cardiac magnetic resonance imaging (MRI), throat swabs for Streptococci and streptococcal serology would have made it possible to diagnose Brecht's cardiac symptoms in his adolescence without a doubt and to differentiate them from functional heart complaints. His death is verified by medical documents clearly documenting bacterial endocarditis with evidence of coli bacteria caused by urological interventions with subsequent febrile episodes and pyelonephritis.