Pleurodynia: Symptoms, Types, Causes and Treatment

Pleurodynia, sometimes called "Bornholm disease," is a sudden and intensely painful condition affecting the muscles in the chest and upper abdomen. While its name might not be familiar to everyone, pleurodynia has been responsible for clusters of outbreaks around the world, causing discomfort and concern for those affected. Understanding pleurodynia’s symptoms, distinct types, underlying causes, and evidence-based treatments is crucial for both patients and healthcare professionals. This article provides an in-depth, human-centered overview of pleurodynia, drawing from research studies to offer a comprehensive resource.

Symptoms of Pleurodynia

Pleurodynia presents in a dramatic and memorable way: sudden, severe pain in the chest or upper abdomen, often with additional symptoms that can at first be mistaken for other illnesses. Recognizing the core symptoms is essential for timely diagnosis and management.

Symptom	Description	Onset	Source(s)
Chest Pain	Sharp, stabbing or aching pain	Sudden, intense	1 5
Abdominal Pain	Discomfort in the upper abdomen	May alternate with chest pain	1 5
Fever	Mild to moderate temperature rise	May accompany pain	5
Muscle Tenderness	Soreness in affected muscles	With pain episodes	5

Table 1: Key Symptoms

Overview of Pleurodynia Symptoms

Pleurodynia is notorious for its abrupt onset and severe pain. The pain is typically localized to the chest or upper abdomen, leading many to believe they are having heart or lung problems. It may come in waves, intensifying with each episode, and can last anywhere from a few seconds to several minutes.

Chest and Abdominal Pain

• The hallmark symptom is a sharp, stabbing, or aching pain most often felt in the lower chest, sometimes radiating to the upper abdomen.
• Pain is often described as severe and can be frightening, especially during the first attack 1 5.
• Movement, deep breathing, or coughing can worsen the pain, making it difficult for patients to move or breathe comfortably.

Associated Features

• Fever: Many patients experience a mild to moderate fever alongside muscle pain. This systemic symptom can make pleurodynia feel similar to the flu or a respiratory infection 5.
• Muscle Tenderness: There can be noticeable soreness or tenderness of the chest or abdominal muscles between attacks.
• Recurrent Attacks: The pain often comes in episodes, with periods of relief between attacks. These episodes can persist for several days before resolving.

Uncommon and Related Symptoms

• Some patients may also experience headaches, sore throat, or fatigue, particularly if the underlying cause is viral, as is often the case 5.
• In rare cases, pleurodynia can be associated with other complications such as pericarditis or meningitis, depending on the viral agent involved 5.

Types of Pleurodynia

Not all cases of pleurodynia are exactly the same. The term encompasses several related clinical entities, each with its own characteristics. Understanding the types helps clarify the spectrum of the disease.

Type	Clinical Features	Associated Conditions	Source(s)
Epidemic	Sudden outbreaks, clusters	Often viral; may co-occur with pericarditis, meningitis	1 5
Sporadic	Isolated cases	May mimic epidemic type; less common co-infections	5
Viral-associated	Linked with enteroviruses	Can lead to carditis, pericarditis, or meningitis	2 3 4 5

Table 2: Types of Pleurodynia

Epidemic Pleurodynia

• Epidemic pleurodynia refers to outbreaks of the disease, often affecting multiple individuals in a community or region, typically during summer and early fall 1 5.
• These outbreaks are usually linked to specific viral infections, most notably the Coxsackie B group of enteroviruses 1 5.
• Epidemic cases may be associated with other syndromes such as acute benign pericarditis or aseptic meningitis 5.

Sporadic Pleurodynia

• Sporadic cases occur less frequently and are not part of a recognized outbreak.
• While they share similar symptoms with epidemic cases, they are less likely to be associated with concurrent viral syndromes 5.

Viral-associated and Complicated Cases

• Viral-associated pleurodynia is the most common, with enteroviruses (especially Coxsackie B and echoviruses) as the main culprits 2 3 4 5.
• In some instances, pleurodynia appears with or leads to complications such as:
  • Pericarditis (inflammation of the heart's lining)
  • Myocarditis (inflammation of the heart muscle)
  • Aseptic meningitis (inflammation of the brain's lining without bacterial infection) 5
• These associations are important for clinicians, as they may indicate a more serious underlying viral infection.

Clinical Overlap

• The boundaries between these types are not strict; a single patient may experience pleurodynia alongside pericarditis or meningitis, especially during epidemic outbreaks 5.
• The common thread is the acute, severe muscle pain of the chest or abdomen, but the presence of complications necessitates careful evaluation.

Causes of Pleurodynia

Understanding the causes of pleurodynia is key to both prevention and effective treatment. Decades of research have pinpointed specific viral agents as the primary culprits, with certain viruses being particularly notorious for causing outbreaks.

Cause	Main Agents	Associated Conditions	Source(s)
Coxsackie B Virus	B1, B2, B3, B5	Pericarditis, myocarditis, meningitis	1 3 5
Echoviruses	Types 6, 19, others	Carditis, pleurodynia	2 4
Other Enteroviruses	Various	Cardiac and non-cardiac complications	3 5

Table 3: Main Causes of Pleurodynia

Coxsackie Viruses: The Primary Culprits

• Coxsackie B viruses are the most frequently identified cause of pleurodynia, especially in epidemic cases 1 3 5.
  • These viruses are part of the enterovirus family and are known for their ability to cause a wide range of illnesses, from mild respiratory infections to severe cardiac disease.
  • Coxsackie B5, in particular, has been implicated in several large outbreaks and is commonly associated with pleurodynia, pericarditis, and aseptic meningitis 5.

Echoviruses and Other Enteroviruses

• Echoviruses (especially types 6 and 19) are also strongly associated with pleurodynia, sometimes in conjunction with cardiac involvement such as myocarditis or pericarditis 2 4.
• Other enteroviruses can occasionally cause pleurodynia, particularly in individuals with weakened immune systems or those exposed during outbreaks 3.

Pathogenesis: How the Viruses Cause Disease

• After entering the body, these viruses typically infect the throat or gastrointestinal tract.
• The viruses can then spread to the muscles of the chest or abdomen, leading to the intense pain and inflammation characteristic of pleurodynia 1 5.
• In some cases, the virus can also infect the lining of the heart (pericardium) or the brain (meninges), causing additional symptoms and complications.

Transmission

• These viruses are highly contagious, spreading via respiratory droplets, close personal contact, or contaminated surfaces.
• Outbreaks often occur in summer and early fall, particularly among children and young adults 5.

Immunologic Response

• During infection, the body mounts an immune response, producing neutralizing antibodies to fight the virus 1.
• This immune response is generally effective, leading to symptom resolution within a week or two in most cases.

Treatment of Pleurodynia

While pleurodynia can be intensely painful and alarming, the good news is that it is usually self-limiting, with most patients recovering fully without complications. Treatment focuses on alleviating symptoms and supporting recovery.

Treatment	Purpose	Notes	Source(s)
Pain Relief	Reduce discomfort	NSAIDs, acetaminophen	5
Rest	Aid recovery	Essential during acute phase	5
Hydration	Support healing	Especially with fever	5
Monitor for Complications	Detect serious illness	Cardiac or neurologic signs	3 5

Table 4: Main Treatment Approaches

Symptomatic Relief

• Pain Management:
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are commonly used to reduce muscle pain and inflammation.
  • Acetaminophen can also help control fever and discomfort 5.
• Rest:
  • Adequate rest is crucial during the acute phase, as exertion can worsen pain and prolong recovery 5.
• Hydration:
  • Maintaining fluid intake is important, particularly if fever is present.

Monitoring and Supportive Care

• Watch for Complications:
  • Although most cases resolve without incident, some may develop more serious viral complications such as myocarditis (heart inflammation) or meningitis.
  • Any new symptoms—such as chest pain that feels different, shortness of breath, confusion, or persistent fever—should prompt further medical evaluation 3 5.

Special Considerations

• Hospitalization:
  • Rarely, severe complications or inability to control pain at home may necessitate hospital care.
• Antivirals and Antibiotics:
  • There are currently no specific antiviral drugs for the viruses that cause pleurodynia, and antibiotics are not effective unless there is a secondary bacterial infection 5.

Prognosis

• Most patients recover fully within 1–2 weeks, and lingering effects are rare.
• Long-term complications are uncommon, but when present (such as chronic pericarditis), they require specialist care 5.

Conclusion

Pleurodynia remains an important, though often under-recognized, viral illness with a distinctive clinical presentation. Understanding its symptoms, various types, causes, and management options empowers both patients and clinicians to respond appropriately.

Main Points Covered:

• Sudden, intense chest or upper abdominal pain is the hallmark of pleurodynia, often accompanied by fever and muscle tenderness.
• The condition exists in several forms, including epidemic and sporadic cases, with potential complications such as pericarditis and meningitis.
• Coxsackie B viruses and echoviruses are the principal viral agents behind pleurodynia, frequently causing outbreaks.
• Treatment is mainly supportive, focusing on pain relief, rest, and hydration, with careful monitoring for complications.
• Most individuals recover fully, but awareness of potential complications ensures prompt and effective care when needed.

By recognizing and understanding pleurodynia, healthcare providers and patients alike can help mitigate its impact and ensure the best possible outcomes.