Pleurodynia Clinical Presentation

  • Author: Irina Petrache, MD; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: Aug 5, 2011
 

History

The onset of chest pain is acute. During attacks, the pain is severe, intense, and excruciating, lasting seconds to a minute. Pain is paroxysmal, occurring in attacks separated by minutes to hours. Severe attacks can result in difficulty breathing. The thoracic pain is usually over the lower ribs and is unilateral, but it can also occur over the front, back, or substernal area. Between attacks, patients usually have a constant, dull, pleuritic chest pain. The attacks usually persist for 3-5 days and rarely last longer than a month and may go through phases of remission and exacerbation.

Associated symptoms related to the viral infection may include the following:

  • Upper respiratory tract symptoms, including sore throat, rhinitis, and dry cough
  • Constitutional symptoms, including headaches (50%), fever, and malaise
  • GI symptoms, including nausea, vomiting, diarrhea (50%); abdominal pain (usually in the epigastric area) in children
  • Testicular pain (ie, orchitis) in 10% of males
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Physical

Fever (97%) and appropriate heart rate response (ie, tachycardia)

Respiratory system findings - Pharyngitis (85%), including herpangina, visible splinting of the chest during attacks, localized chest wall tenderness in the same area of pain (25%), and pleural friction rub (25%)

Other potential signs associated with the coxsackievirus B infection - Otitis (25%) and dermatitis (30%)

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Causes

The classic etiologic agent for pleurodynia is coxsackievirus B, serotypes B1, B2, B3, B4, and B5, which are small, nonenveloped RNA viruses, in which an icosahedral capsid encloses the single-stranded RNA genome.

Other nonpolio enteroviruses, including echoviruses type 6 and 19 and coxsackievirus A, are also reported to cause syndromes very similar to that of coxsackievirus B infection, including pleurodynia.

Humans are the only known reservoir of the enteroviruses; transmission occurs via the fecal-oral route. The incubation time is usually 2-5 days. Potential risk factors for the transmission of the enteroviruses are poor sanitation and overcrowding. Intrafamilial spread is common.

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Contributor Information and Disclosures
Author

Irina Petrache, MD  Associate Professor of Medicine, Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University

Irina Petrache, MD is a member of the following medical societies: American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Karina A Serban, MD  Fellow, Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University Purdue University Indianapolis School of Medicine

Karina A Serban, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Helen M Hollingsworth, MD  Director, Adult Asthma and Allergy Services, Associate Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Boston Medical Center

Helen M Hollingsworth, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American Thoracic Society, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gregg T Anders, DO  Medical Director, Great Plains Regional Medical Command , Brooke Army Medical Center; Clinical Associate Professor, Department of Internal Medicine, Division of Pulmonary Disease, University of Texas Health Science Center at San Antonio

Gregg T Anders, DO is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Ninotchka Liban Sigua, MD, to the development and writing of this article.

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