Pleurodynia Clinical Presentation

Updated: Aug 13, 2015
  • Author: Irina Petrache, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Presentation

History

Pleurodynia should be considered in all cases of acute and subacute chest pain that present in the ER or in internal medicine, cardiology, or cardiothoracic surgery outpatient clinics. 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, coxsackievirus A, and human parechovirus type 3 (HPeV3), [4] 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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