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Pleurodynia

What Is It, Causes, Symptoms, and More

Author:Lily Guo

Editors:Alyssa Haag,Ian Mannarino, MD, MBA,Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:David G. Walker


What is pleurodynia?

Pleurodynia, formerly called Bornholm disease, refers to sudden and severe chest or upper abdominal pain, typically caused by an enteroviral infection (e.g., coxsackie A, coxsackie B, and echovirus). Pleurodynia is most commonly caused by group B coxsackie virus and typically occurs as an epidemic, spreading and affecting a community of people. It is commonly associated with fever, malaise, and/or headaches. Nonetheless, sporadic cases may occasionally occur. Epidemic pleurodynia spreads between humans by fecal-oral contamination or by direct mouth-to-mouth contact, such as while kissing. 

Inflammation of the intercostal muscles.

What causes pleurodynia?

Pleurodynia is commonly caused by an enterovirus infection of the striated intercostal muscles of the chest wall, resulting in inflammation and, subsequently, pain. The viral infection can further cause necrosis of the intercostal muscles. 

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What is the difference between pleurodynia and pleurisy?

The difference between pleurodynia and pleurisy is the underlying cause and source of pain. In pleurodynia, the pain is due to inflammation of the muscles in the chest that join adjacent ribs together (i.e., the intercostal muscles). In contrast, pleurisy, also known as pleuritis, results from inflammation of the pleura, which is the two layers of thin tissue encapsulating and protecting the lungs. Pleurisy can occur concurrently in some cases of pleurodynia and is similarly caused by viral and bacterial infection. 

What are the signs and symptoms of pleurodynia?

Signs and symptoms of pleurodynia include sudden onset chest or abdominal pain that occurs a few days after exposure to an enterovirus. The chest pain is typically pleuritic in nature, meaning it worsens with a deep breath or with any movement that causes the pleura to rub against the chest wall (e.g., lying down). The pain is typically unilateral, only affecting half or part of the chest or abdomen, and may radiate to the neck or arms. Pain may occur as knife-like spasms lasting 15 to 30 minutes at a time, followed by a period of relief or dull ache. The pain can be associated with profuse sweating. 

Other non-specific symptoms include headache, fever, chills, malaise, cough, sore throat, as well as muscle aches and pains. The symptoms typically last about 2-4 days and, in rare cases, can last three weeks or longer. Epidemic pleurodynia most commonly occurs in the summer and early fall and usually affects people younger than the age of 30. Nonetheless, older people may also be affected. It is common for children to contract an enterovirus, particularly at daycare centers where they tend to put toys or fingers into their mouth. 

How is pleurodynia diagnosed?

Pleurodynia is often diagnosed on a physical exam in addition to an individual’s medical history. Laboratory testing, such as white blood cell count, can be ordered to assess for infection. While the total number of white blood cells will typically be normal in an individual with pleurodynia, the number of polymorphonuclear leukocytes (i.e., a subtype of leukocytes that protect the body against infectious diseases) will be elevated. The levels of creatine kinase, which is an enzyme found in the heart, brain, and skeletal muscle, may also be elevated in an individual with pleurodynia due to muscle inflammation. 

Imaging such as chest and abdominal X-ray may be ordered; however, they typically appear normal in individuals with pleurodynia. An electrocardiogram (ECG) may also be ordered to assess for conditions related to the heart (e.g., myocardial infarction) that can present with similar signs and symptoms.

How is pleurodynia treated?

In most individuals, pleurodynia is a self-remitting infection that goes away on its own within a few days and, therefore, is typically managed by treating the individual’s symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be administered to control pain and fever. Notably, if a child has pleurodynia, aspirin should not be administered due to the risk of adverse side effects. In severe cases, a peripheral nerve block with 1% lidocaine can be injected into the intercostal nerve to help mitigate the pain.

What are the most important facts to know about pleurodynia?

Pleurodynia refers to when a viral infection, typically caused by coxsackie B virus, causes severe, intermittent pleuritic chest or upper abdominal pain as a result of inflammation of the intercostal muscles in the chest wall. It is most common in younger adults and children. Other associated symptoms of pleurodynia include fever, cough, and sore throat. Diagnosis is commonly made on physical exam, though other diagnostic tests may be ordered to rule out differential diagnoses. It is a self-remitting condition and typically resolves on its own within 2-4 days. NSAIDs can be used to control pain, and a peripheral nerve block can be used in cases where the pain is severe.

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Related links

Coxsackievirus
Anatomy clinical correlates: Pleura and lungs
Pleural effusion

Resources for research and reference

Finn, J. J., Weller,  T. H., & Morgan, H. R. (1949). Epidemic pleurodynia: Clinical and etiologic studies based on one hundred and fourteen cases. Archives of Internal Medicine, 83(3): 305-321. DOI: 10.1001/archinte.1949.00220320059005

Lal, A., Akhtar, J., Isaac, S., Mishra, A. K., Khan, M. S., Noreldin, M., & Abraham, G. M. (2018). Unusual cause of chest pain, bornholm disease, a forgotten entity; case report and review of literature. Respiratory Medicine Case Reports, 25: 270–273. DOI: 10.1016/j.rmcr.2018.10.005 

Tesini, B. L. (2021). Overview of enterovirus infections. In MSD Manual Consumer Version. Retrieved May 5, 2022, from https://www.msdmanuals.com/home/infections/enteroviruses/overview-of-enterovirus-infections 

Tian, L., Yang, Y., Li, C., Chen, J., Li, Z., Li, X., Li, S., Wu, F., Hu, Z., & Yang, Z. (2018). The cytotoxicity of coxsackievirus B3 is associated with a blockage of autophagic flux mediated by reduced syntaxin 17 expression. Cell Death & Disease, 9. DOI: 10.1038/s41419-018-0271-0