Pleurodynia is a viral infection that causes sudden, severe pain in the chest or abdomen, typically accompanied by fever. It’s caused by a group of enteroviruses called coxsackievirus B, and while the pain can be intense enough to mimic a heart attack or other emergencies, the condition is self-limiting and usually resolves within a few days. You may also see it called Bornholm disease, Devil’s grip, or epidemic myalgia.
What Causes Pleurodynia
The culprit behind pleurodynia is coxsackievirus B, a family of enteroviruses with six known serotypes (B1 through B6). The virus typically enters through the throat, multiplies in lymphatic tissue, and then travels through the bloodstream to skeletal muscle. Once there, it targets striated muscle fibers in the trunk, which is what produces the characteristic stabbing pain in the chest wall or abdomen.
Transmission follows a pattern similar to other enteroviruses: the virus spreads through close contact, and outbreaks tend to cluster within families and communities. Careful history-taking often reveals a high attack rate among close contacts and household members. Outbreaks occur more frequently in summer and early fall. In the United States, coxsackievirus B4 accounted for about 1.9% of all enterovirus infections in 2016, according to CDC surveillance data, though pleurodynia cases specifically are thought to be underreported.
How the Pain Feels
The hallmark of pleurodynia is pain that arrives suddenly and sharply. It typically strikes in the lower chest, upper abdomen, or the area just below the breastbone. The pain is often described as stabbing or lancinating, and it tends to come and go in waves rather than remaining constant. Breathing deeply, coughing, or moving can make it worse, which is why it’s sometimes confused with pleurisy (inflammation of the lung lining).
Where the pain localizes depends partly on age. In adults, the pain is predominantly in the chest. In children, it more often settles in the abdomen, which can lead to initial concern about appendicitis or other surgical emergencies. The muscles of the trunk may become visibly swollen and tender to the touch.
Along with pain, most people experience fever, headache, sore throat, and a general feeling of being unwell. These flu-like symptoms overlap with many other infections, which is one reason pleurodynia can be tricky to recognize on its own.
How It Differs From Serious Chest Pain
Because pleurodynia produces severe chest pain, one of the first priorities is ruling out life-threatening causes like a heart attack, pulmonary embolism, collapsed lung, or aortic dissection. A few features help distinguish pleurodynia from cardiac chest pain. Heart-related pain typically feels like deep pressure that radiates into the shoulder, arm, or neck, and it carries higher risk in men over 60. Pleurodynia pain, by contrast, tends to be sharp and localized, often reproducible when you press on the affected area, and it worsens with breathing or movement.
A chest X-ray is usually normal in pleurodynia, which helps rule out pneumonia or fluid around the lungs. If there’s any doubt about a cardiac cause, additional testing can quickly clarify the picture. The combination of sharp, positional chest pain in a younger person with fever and recent viral symptoms points strongly toward an infectious cause rather than a cardiac one.
Diagnosis
There is no single test that confirms pleurodynia. Diagnosis relies mainly on recognizing the characteristic pattern: sudden onset of sharp chest or abdominal pain with fever, especially during summer or early fall, and particularly when similar illness has appeared in close contacts. A physical exam showing tender, swollen trunk muscles strengthens the diagnosis.
Lab work and imaging are used primarily to exclude other causes. A chest X-ray rules out pneumonia or pleural effusion. Blood tests can help rule out heart attack. Viral cultures or molecular testing can sometimes identify coxsackievirus B, but these tests are not always performed in clinical practice because the illness is typically mild and self-resolving.
Recovery and What to Expect
Symptoms usually subside within two to four days, though pain lasting up to 45 days has been documented in rare cases. One distinctive feature of pleurodynia is its tendency to recur. After the initial episode resolves, the pain may return within a few days and can persist or come and go over several weeks. This relapsing pattern can be frustrating, but each recurrence tends to be milder than the first.
Treatment is entirely supportive. Over-the-counter anti-inflammatory pain relievers help manage the chest or abdominal pain, and rest allows the body to clear the virus. There is no antiviral medication that targets coxsackievirus B, so the goal is comfort while the immune system does its work. Most people recover fully without lasting effects.
Possible Complications
Pleurodynia itself is rarely dangerous, but coxsackievirus B can occasionally affect organs beyond skeletal muscle. The most commonly reported complications are aseptic meningitis (viral inflammation of the membranes surrounding the brain) and orchitis (testicular inflammation) in males. Less frequently, the virus can cause myocarditis or pericarditis, forms of heart inflammation that produce symptoms like chest pressure, shortness of breath, or rapid heartbeat.
There is also some evidence linking coxsackievirus B infection to a post-viral fatigue syndrome and, in rarer cases, to the development of type 1 diabetes in children, though the exact relationship remains an area of active study. These complications are uncommon, and the vast majority of people with pleurodynia experience nothing more than the characteristic pain and fever before making a full recovery.