An Overview of Pleurodynia

Pleurodynia is a term describing sudden, severe pain in the chest or abdomen. It occurs when a viral infection affects the lining of the lungs or muscles near them in the chest.

Epidemic pleurodynia, also called Bornholm disease, causes symptoms of pain and fever recurring in spasms, often with general discomfort and headache. The pain is often knife-like and worsens with breathing and movement.

A diagnosis is usually made based on symptoms and physical exam alone and is often suspected when an epidemic is occurring. Infections typically last four to six days and are most common in people under the age of 30.

This article explains pleurodynia, its symptoms, and its relationship to certain enteroviruses. It presents information on pleurodynia diagnosis, treatment, and complications that may occur.

What Is Pleurodynia?

Pleurodynia 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 in the muscles that causes the symptoms.

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

Pleurodynia Symptoms

Pleurodynia symptoms 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 the chest or abdomen and tends to occur in the 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 symptoms including

• A fever
• Abdominal pain
• Lower back pain
• Sore throat
• Nausea
• 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 it recurs. Fever may also be intermittent, but it doesn't come and go as quickly as muscle pain.

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.

Pleurodynia Causes

Pleurodynia is a viral infection caused by several viruses known as enteroviruses. These viruses include:

• Coxsackie A virus (strains A1, 2, 4, 6, 9, 10, and 16)
• Coxsackie B virus (strains B1 to 5)
• Echovirus (strains E1-3, 6, 7, 9, 11, 12, 14. 16, 19, 24, 25, and 30)

The majority of people with pleurodynia are infected with Coxsackie B. The disease usually occurs in epidemics, though isolated cases (sporadic cases) may occur. It affects both children and adults.

Pleurodynia Diagnosis

A pleurodynia diagnosis is usually made based on symptoms alone, in addition to 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 white blood cells known as polymorphonuclear leukocytes.

A blood test called creatinine kinase is not often checked, but may be elevated in people with pleurodynia due to muscle inflammation. 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.

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.

Pleurodynia Treatment

There is no specific treatment available for pleurodynia. Instead, 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% to 10% 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 the connection is unproven, some evidence suggests the infection that causes pleurodynia may be implicated in the onset of type 1 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.

Preventing Pleurodynia

Pleurodynia can't always be prevented, 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, consistent handwashing is paramount, as well as good hygiene practices such as not sharing glasses or utensils. After a person is infected, the virus persists in the mouth, throat, and gastrointestinal tract for roughly two weeks.