eMedicine Specialties > Pulmonology > Pleural Disorders

Pleurodynia: Follow-up

Author: Irina Petrache, MD, Associate Professor of Medicine, Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University
Coauthor(s): Ninotchka Liban Sigua, MD, Fellow, Department of Pulmonary and Critical Care, Indiana University
Contributor Information and Disclosures

Updated: Apr 17, 2009

Follow-up

Further Outpatient Care

  • Patients must receive follow-up care with their primary care providers to ensure that other potential coxsackievirus B–associated complications are diagnosed and managed in a timely manner.

Deterrence/Prevention

  • Common hygiene measures aid in the prevention of the oral-fecal transmission of coxsackievirus B. An outbreak of pleurodynia among high school football players was traced to contaminated water; therefore, avoid direct oral contact with common drinking or ice containers in favor of individual water containers and ice packs.14
  • Coxsackievirus B is a small RNA virus that lacks a lipoprotein envelope and, hence, may be resistant to physical and chemical inactivation. Good sterilization techniques that include ethylene oxide have been shown to inactivate the virus on electrophysiologic catheters.15

Complications

  • Direct complications of pleurodynia are rare. Splinting from pain may result in atelectasis and shortness of breath.
  • A postviral syndrome, also called fatigue-dysphoria syndrome, is described in children who were seropositive for coxsackievirus B and who complained of fatigue, weakness, sore throats, and dysphoria. This syndrome may also complicate the patient's recovery.
  • In rare cases, coxsackievirus B infection may be complicated by carditis, aseptic meningitis, constrictive pericarditis, orchitis, myalgic encephalomyelitis,16 hemorrhagic conjunctivitis,17 hepatitis, pancreatitis,18 and juvenile-onset diabetes mellitus.
  • Dilated cardiomyopathy is a complication of viral myocarditis. It may be acute or related to severe muscle necrosis, or it may occur several years later, possibly due to chronic inflammation and fibrosis as a result of an immune-mediated process.19

Prognosis

  • The prognosis is good, with complete recovery in most cases. The return to normal health may be gradual after a period of weakness and fatigue. No deaths are reported as a direct result of pleurodynia.

Patient Education

  • Encourage proper hygiene measures in the patient's household to avoid intrafamilial spread of the virus.
  • For excellent patient education resources, visit eMedicine's Lung and Airway Center. Also, see eMedicine's patient education article Chest Pain.

Miscellaneous

Medicolegal Pitfalls

  • Failure to correctly diagnose life-threatening causes of acute severe onset of chest pain (see Differentials), including pulmonary embolism,20 myocardial infarction, or aortic dissection
  • Failure to provide a thorough clinical evaluation followed by a proper investigative plan, which should (in most cases) aid in the appropriate diagnosis of such disorders

Special Concerns

  • Coxsackievirus B may be transmitted to the fetus during pregnancy by transplacental route or during delivery. It may be associated with spontaneous abortions before 12 weeks' gestation. It may also be related to increased incidence of congenital heart defects, and early-onset insulin-dependent diabetes mellitus. Placental infection by the virus may lead to perinatal morbidity and death.21
 


More on Pleurodynia

Overview: Pleurodynia
Differential Diagnoses & Workup: Pleurodynia
Treatment & Medication: Pleurodynia
Follow-up: Pleurodynia
References
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References

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Further Reading

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Keywords

pleurodynia, pleuritis, pleuritic pain, lancinating chest pain, costalgia, epidemic pleurodynia, Bornholm disease, Bornholm's disease, Devil grip, Devil's grip, epidemic myalgia, coxsackievirus B, enteroviruses, meningitis, carditis, Sylvest's disease, Sylvest disease, epidemic benign dry pleurisy

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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)

Ninotchka Liban Sigua, MD, Fellow, Department of Pulmonary and Critical Care, Indiana University
Ninotchka Liban Sigua, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gregg T Anders, DO, Medical Director, Great Plains Regional Medical Command , Brook 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.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint 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, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
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.

 
 
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