Epidemic Pleurodynia


What Is It?

The pleura is the lining around your lungs. Pleurodynia is a general term for pain from this lining — pain in the chest or upper abdomen when you breathe. Epidemic pleurodynia, which has a misleading name, refers to an infection caused by one of several viruses. This type of infection can cause a similar type of pain as the pain that comes from the lining around the lungs. However, in epidemic pleurodynia, the pain comes from the muscles in the chest that join ribs together.

Epidemic pleurodynia also is called Bornholm disease, Sylvest’s disease, devil’s grip and epidemic benign dry pleurisy. It usually is caused by one of the group B coxsackieviruses, and less often caused by a group A coxsackievirus or an echovirus.

Group B coxsackieviruses that cause pleurodynia are in the feces of infected people. Other people become infected with the virus if they touch contaminated items then put their fingers in their mouths before washing them properly. Contaminated items can include soiled diapers, shared toys and toilets. Epidemic pleurodynia is contagious and occurs in clusters. Up to 90 percent of epidemics occur in the summer and early fall. The illness most commonly strikes people younger than age 30, although older people also may be affected. Once infected, a person can spread the virus to others, so good hygiene, including careful handwashing, is important.


Once inside the body, the coxsackieviruses multiply in the throat and intestines, then spread into the bloodstream. At this point, the body’s immune defenses often can limit the infection and prevent the person from developing symptoms. At other times, the immune defenses are less successful, and the person develops a fever or other symptoms, such as headache, nausea and vomiting or sore throat. Only a few infected people develop the classic muscle pain in the chest and upper abdomen that gives the disease its name. In these people, the coxsackievirus infection has settled in the muscles of the chest and upper abdomen, causing inflammation there.

The chest pain can be a severe, stabbing pain, or it can be a milder cramping in the side. Usually, only one side of the chest or abdomen is affected, although occasionally the pain can include muscles of the neck or arms.

The pain usually comes in waves that last 15 to 30 minutes, although some people report having pain episodes that last for several hours. The pain can be so severe that you have trouble breathing, sweat a lot, and become anxious.


Your doctor will ask about your symptoms and will examine you. During the examination, your doctor may press on muscles in your chest to see if the pressure triggers a spasm of pain. Often, your doctor can diagnose the problem without any special tests, especially if there is an outbreak of the illness in your area.

If your doctor is not sure of the diagnosis, he or she may need to order additional tests. These may include blood tests, X-rays of the chest or abdomen, an electrocardiogram (EKG) and a laboratory examination of body fluids or feces. You also may need a biopsy of the muscle that hurts. In a biopsy, a small piece of the muscle is removed and examined in a laboratory.

Expected Duration

Symptoms of pleurodynia usually last about one to two days in children and about two to six days in adults. In some people, the pain and fever can return after it has been gone for a day or two. Very rarely, a person will have the pain and fever come and go over a period of three weeks or longer.


The viruses that cause epidemic pleurodynia can spread very easily among young children, who tend to put toys or fingers into their mouth. The disease is most likely to spread in day-care centers. The best way to prevent infection is to wash hands thoroughly, especially before meals or after changing a diaper changing or using the bathroom. There is no vaccine to prevent pleurodynia.


In people who are otherwise healthy, pleurodynia is a harmless infection that goes away on its own within a few days. To treat the muscle pain, your doctor probably will recommend that you apply a heating pad to the affected muscles and take over-the-counter pain relievers. If necessary, your doctor may prescribe narcotic pain medication.

A word of caution for parents: Aspirin should not be given to children with pleurodynia because of the risk of Reye’s syndrome, a serious reaction causing brain and liver injury in children who take aspirin during certain viral illnesses.

When To Call A Professional

Call your doctor immediately if you or someone in your family develops severe chest pain, even if there is a known outbreak of epidemic pleurodynia in your area. It’s important to see a doctor as quickly as possible because the symptoms of epidemic pleurodynia can be very similar to symptoms of life-threatening illnesses, including a heart attack.


Almost all generally healthy individuals recover completely from pleurodynia. However, about 5 percent of patients develop acute viral meningitis as a complication of the coxsackievirus infection, and about 5 percent of adult males develop orchitis. Less common complications include hepatitis, pericarditis and myocarditis.

Johns Hopkins patient information

Last revised:

Diseases and Conditions Center

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.