An Overview of Pleurodynia

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young woman with chest pain due to pleurodynia

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Pleurodynia is a viral infection that can cause the sudden onset of severe pain in the chest or abdomen, with episodes of pain and fever recurring in spasms. Most infections occur as part of an epidemic and are most common in people under the age of 30.

The pain is often knife-like and worsens with breathing and movement. The diagnosis is usually made based on symptoms and physical exam alone and is often suspected when an epidemic is occurring. There are no specific treatments for the viruses that cause pleurodynia, and management focuses on pain relief until the symptoms resolve. On occasion, complications such as meningitis or orchitis may occur.

Definition

Pleurodynia literally means pain in the pleura, the membranes that line the lungs. It has been coined the "devil's grip" due to the sensation it causes, as if someone has an iron grip around your chest. Though it may feel like the pain stems from the lungs, it is actually inflammation of muscles that causes the symptoms.

Pleurodynia is known by other names as well, including Bornholm disease, Bamle disease, Sylvest's disease, dry pleurisy, epidemic transient diaphragmatic spasm, and another unpleasant phrase, "The Grasp of the Phantom."

Symptoms

Symptoms of pleurodynia often include the sudden onset of pleuritic chest pain or abdominal pain. Pleuritic chest pain refers to pain in the chest that is often sharp and worsens with a deep breath or with movement. The pain often occurs on only one side of chest or abdomen and tends to occur in the lower chest region near the lower ribs. On occasion, the pain will extend to the neck or arms.

Pleurodynia often comes on suddenly, in people who were previously healthy. It can be accompanied by a fever, abdominal pain, lower back pain, sore throat, nausea, and a headache. In adults, chest pain is more common, whereas abdominal pain is more common in children.

The pain often occurs in spasms lasting from 15 minutes to 30 minutes, though episodes may last for only a few minutes, or in contrast, may persist for hours. The pain is then followed by a period of relief before both the pain and fever recurs.

Due to its sudden onset, the severity of pain, and the sensation of feeling like your chest is being strangled or stabbed with a knife, it often causes intense anxiety. Many adults with the infection are concerned that they are having a heart attack.

On examination, people usually have slight swelling along with pain with palpation over the lower ribs (in the area where the diaphragm attaches). During the pain episodes, people are often noted to be sweaty, have a rapid, shallow respiratory rate, and often appear very ill and frightened. When listening to the chest, a physician may hear something known as a pleural rub; a creaking or grating sound heard through a stethoscope.

Causes

Pleurodynia, is a viral infection with several viruses known as enteroviruses. Coxsackie A virus (strains A1, 2, 4, 6, 9, 10, and 16), Coxsackie B virus (strains B1 to 5), and echovirus (strains E1-3, 6, 7, 9, 11, 12, 14. 16, 19, 24, 25, and 30) have all been isolated in people with the disease.

The majority of people with pleurodynia are infected with Coxsackie B, and the disease usually occurs in epidemics, though isolated cases (sporadic cases) may occur. This isn't always recognized as many people are thought to have subclinical infections (no symptoms of the infection).

It's not certain exactly what causes the pain of pleurodynia. Pleuritic chest pain is often associated with inflammation of the pleura, the membranes that line and surround the lungs, but inflammation of the pleura is not thought to occur with pleurodynia. Inflammation of the muscles, particularly the interosseus muscles, is thought to be the underlying cause.

Diagnosis

The diagnosis of pleurodynia is usually made based on the symptoms alone, as well as a person's appearance on physical examination. Laboratory tests, such as a white blood cell count, are often normal, though there may be an increased number of the types of white blood cells known as PMNs. A blood test called creatinine kinase (CK) is not often checked, but may be elevated in people with pleurodynia due to inflammation of the muscles. Imaging tests, such as a chest x-ray, are also usually normal.

After a person is exposed to the virus, the incubation period, or the time between contracting the virus and developing symptoms, is around four days. The symptoms usually last for four days to six days, though symptoms may be present for a day or two, seemingly go away, and then recur later on.

Epidemic pleurodynia is much more common during the summer months in the United States.

Differential Diagnosis

Due to the severity of the pain, the symptoms of pleurodynia are often first thought to be due to another cause, unless the epidemic is known. Adults may double over clutching their chest, and the symptoms can mimic a heart attack.

In children, who often have pain in the abdominal region, mild symptoms may at first be dismissed as colic, but when severe, raise thoughts about appendicitis or peritonitis (inflammation/infection of the abdominal cavity) due to the degree of tenderness.

Treatment

There is no specific treatment for pleurodynia, and treatment focuses on supportive care. Nonsteroidal anti-inflammatory drugs such as Advil (ibuprofen) can be used to reduce pain. Applying warm packs to the tender regions on the chest and abdomen may also provide some relief.

For babies who are less than one month of age, infections with some of the viruses that cause pleurodynia can be very severe. Hospitalization and treatment with immunoglobulin may be recommended.

Complications

Complications of pleurodynia are relatively uncommon, but roughly 5 percent to 10 percent of people with the disease also develop meningitis (inflammation of the meninges, the membranes that surround the brain and spinal cord), or orchitis (inflammation of the testes).

Meningitis can cause a severe headache, stiff neck, high fever, and sometimes seizures or loss of consciousness. Orchitis can cause severe tenderness of the scrotum. Less commonly, inflammation of the heart muscle (myocarditis), lining of the heart (pericarditis), dermato-polymyositis, or chronic fatigue syndrome may occur following the infection. Though it's uncertain, there is some evidence that the infection that causes pleurodynia may be implicated in the onset of type I, juvenile-onset diabetes.

When pleurodynia is contracted during pregnancy, there is a very small risk of miscarriage, as well as a possible (but rare) risk of stillbirth. In children under the age of one month, the infection can be dangerous, and people should seek out medical attention if a young infant demonstrates symptoms (see below).

Prevention

It's not always possible to prevent pleurodynia, but you can reduce your risk by taking precautions as you would against any virus, such as the flu. The virus can be spread by mouth to mouth contact (such as sharing a glass or cup) or fecal-oral contamination. Handling contaminated objects can also result in infection if you touch an object that has been contaminated by the virus and then touch your mouth or eyes.

Careful handwashing is paramount, as well as good hygiene practices such as not sharing glasses or utensils. After a person is infection, the virus persists in the mouth, throat, and gastrointestinal tract for roughly two weeks.

View Article Sources
  • Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. Harrison's Principles of Internal Medicine. New York: Mc Graw Hill education, 2015. Print.
  • Kliegman, Robert M., Bonita Stanton, St Geme III Joseph W., Nina Felice. Schor, Richard E. Behrman, and Waldo E. Nelson. Nelson Textbook of Pediatrics. 20th Edition. Philadelphia, PA: Elsevier, 2015. Print.