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.

Symptoms

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.

Diagnosis

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.