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Pleurodynia – Causes, Symptoms and Treatment

Pleurodynia is a sharp chest pain caused by inflammation of the intercostal muscles or the pleura. It is most commonly associated with viral infections.

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Things worth knowing about "Pleurodynia"

Pleurodynia is a sharp chest pain caused by inflammation of the intercostal muscles or the pleura. It is most commonly associated with viral infections.

What is Pleurodynia?

Pleurodynia refers to an acute, typically sharp or cramping pain in the chest wall or flanks. The term derives from the Greek words pleura (side, rib) and odyne (pain). The pain arises from irritation or inflammation of the intercostal muscles (the muscles between the ribs) or the pleura, the thin membrane lining the lungs and inner chest wall.

A well-known form of this condition is epidemic pleurodynia, also called Bornholm disease. It is caused by Coxsackievirus B and typically occurs in small outbreaks during summer and early autumn.

Causes

Pleurodynia can be triggered by a variety of factors:

Viral infections: Coxsackievirus B is the most common cause of epidemic pleurodynia. Other enteroviruses may also be involved.
Bacterial infections: In rare cases, bacteria can cause pleuritis (inflammation of the pleural membrane) with associated pleurodynia symptoms.
Muscular strain: Intense physical activity or prolonged coughing can irritate the intercostal muscles.
Costochondritis: Inflammation of the cartilage connecting the ribs to the sternum can produce similar chest pain.
Herpes Zoster (shingles): Reactivation of the varicella-zoster virus can cause pain along a nerve segment in the chest area.

Symptoms

Typical symptoms of pleurodynia include:

Sudden onset of sharp or cramping chest pain that worsens with breathing, coughing, or movement
Pain in the side of the chest wall or upper abdomen
Shortness of breath due to guarded, shallow breathing to avoid pain
General malaise, fever, and fatigue (especially with a viral cause)
Occasional headaches or muscle aches

In epidemic pleurodynia, pain episodes tend to come in waves, lasting from a few minutes to several hours. Patients may feel completely well between episodes.

Diagnosis

Because chest pain can have many causes, careful diagnostic evaluation is essential. A physician will typically perform:

Medical history and physical examination: Assessment of pain characteristics, associated symptoms, and possible exposure to infected individuals
ECG (electrocardiogram): To rule out cardiac causes such as a heart attack
Chest X-ray: To evaluate the lungs and pleural space
Blood tests: Inflammatory markers (CRP, white blood cell count) and virological testing may provide important clues
Ultrasound: To detect pleural effusions (fluid accumulation around the lungs)

Treatment

Treatment of pleurodynia depends on the underlying cause:

Symptomatic relief: Anti-inflammatory pain relievers such as ibuprofen or paracetamol help reduce pain and inflammation.
Heat therapy: Applying a heating pad or warm compress to the affected area can relax the muscles and ease discomfort.
Rest: Physical rest supports recovery.
Antiviral or antibiotic therapy: Specific treatment may be required if a bacterial infection or certain viral conditions are confirmed.
Herpes Zoster treatment: Antiviral medications such as aciclovir are indicated when shingles is the underlying cause.

Epidemic pleurodynia typically resolves on its own within one to two weeks. Persistent or severe symptoms always warrant medical evaluation.

When to Seek Medical Attention

Chest pain should always be taken seriously. Immediate medical attention is required if:

The pain is very severe or comes on suddenly
Pain radiates to the arm, jaw, or back
There is significant shortness of breath or bluish discoloration of the lips
High fever and severe illness are present

References

Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 9th edition, Elsevier, 2020.
Cherry J.D.: Enteroviruses and Parechoviruses. In: Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 8th edition, Elsevier, 2019.
World Health Organization (WHO): Enterovirus surveillance guidelines, Geneva, 2015.

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