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Eur J Cardiothorac Surg 2007;32:184. doi:10.1016/j.ejcts.2007.03.005
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Letters to the Editor

Another perspective of the dysphagia due to tuberculosis

Thomas F. Molnara,*, Frank Detterbeckb, Zoltan Balikoc

a Department of Surgery, Medical School, University of Pécs, Hungary
b Division of Thoracic Surgery, Yale University, New Haven, CT, USA
c Department of Pneumonology, Teaching County Hospital of Pécs, Hungary

Received 29 January 2007; accepted 5 March 2007.

* Corresponding author. Address: Department of Surgery, Medical School, University of Pécs, Hungary, H-7632 Pécs, Ifjusag u 12. Tel.: +36 30 640 3362; fax: +36 72 536 496. (Email: mft{at}iseb.pote.hu).

Key Words: Dysphagia • Medical humanities • Tuberculosis • History

We read with interest the article of Rathinam et al. [1].

Tuberculosis was central to the development of the specialty of thoracic surgery, [2] and it is unfortunate that complications of this disease are almost completely forgotten in the modern literature. We commend the authors for calling attention to a symptom of tuberculosis that is relatively rare, yet carries important consequences. We are writing to underscore the paper as well as to broaden the professional horizon by drawing attention to the importance of this disease and symptom throughout history.

The tuberculotic patient can suffer from swallowing problems starting from the pharynx all down to the lower esophageal sphincter – dysmotility due to peritonitis tuberculosa, for instance. Mediastinal (nodal) involvement is really the most plausible cause. Literature provides us with an early description of a patient suffering from dysphagia due to tuberculosis, although the source is outside the usual medical sources [3]. The patient is Joachim, cousin of the main character, Hans Castorp in Thomas Mann's novel Magic Mountain (Der Zauberberg). No one who reads this book will fail to list tuberculosis among possible causes of dysphagia. Thomas Mann, who was himself a thoracic surgical patient, having undergone a bilobectomy [4] – gives a brilliant description of the terminal incapacity of swallowing. Although one might initially suspect recurrent nerve palsy from tuberculous mediastinal node involvement as the cause for the hoarseness, in this case, the diagnosis is laryngeal tuberculosis. The patient suffers from increasing hoarseness, aspiration, debilitation and finally succumbs.

A broad base of knowledge is important, and the case series reported by Rathinam is a good example. Thomas Mann reminds us that even unusual sources like the humanities can also be useful.

References

  1. Rathinam S, Kanagavel M, Tiruvadanan BS, Santhosam R, Chandramohan SM. Dysphagia due to tuberculosis. Eur J Cardiothorac Surg 2006;30:833-836.[Abstract/Free Full Text]
  2. Gaensler EA. The surgery for pulmonary tuberculosis. Am Rev Resp Dis 1982;12:73-84.[Medline]
  3. Mann T. The Magic Mountain (English translation by John E. Woods), First Vintage International Edition, Vintage Books (Random House), New York, New York, 1996; pp. 516–526.
  4. Carter R. The mask of Thomas Mann (1875–1955): medical insights and last illness. Ann Thorac Surg 1998;65:578-585.[CrossRef][Medline]



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S. Rathinam and S. M. Chandramohan
Reply to Molnar et al.
Eur. J. Cardiothorac. Surg., July 1, 2007; 32(1): 184 - 184.
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