Pleurodynia is a viral illness that causes sudden, intense pain in the chest and upper abdomen. Also known as Bornholm disease or “devil’s grip,” it’s caused by a group of enteroviruses and typically resolves on its own within days to a few weeks, though the pain can be severe enough to mimic a heart attack or other emergency.
What Causes Pleurodynia
The condition is triggered by enteroviruses, most commonly Coxsackievirus B3 and Coxsackievirus A9. Less frequently, other strains of Coxsackievirus A and B or echoviruses can be responsible. These viruses spread through contact with respiratory droplets or contaminated surfaces, much like the common cold.
Once the virus enters the body, it targets the muscles between the ribs (the intercostal muscles) and the thin membrane lining the chest cavity, called the pleura. The outer layer of this membrane is packed with pain-sensing nerve fibers, which is why inflammation there produces such sharp, noticeable pain. The virus essentially inflames the tissue surrounding your lungs and ribcage, causing the muscles in that area to spasm.
Outbreaks tend to cluster in summer and early fall, when enteroviruses circulate most actively. The disease was first described in Norway and later named after Bornholm, a Danish island where a notable outbreak occurred. The link to Coxsackievirus wasn’t established until 1949.
What the Pain Feels Like
The hallmark of pleurodynia is a sudden, stabbing pain in the lower chest or upper abdomen. It often comes on in spasms, meaning you might feel fine for a stretch and then get hit with a wave of sharp pain. Breathing deeply, coughing, or moving can make it worse, since these actions stretch the inflamed muscles and pleural lining.
In children, the pain frequently shows up in the abdomen rather than the chest, which can lead to confusion with appendicitis or other abdominal emergencies. In adults, the chest pain is more typical and can be alarming enough to prompt a trip to the emergency room.
Other Symptoms Beyond Pain
Pleurodynia rarely shows up as pain alone. Nearly all patients (about 97%) develop a fever. Sore throat is reported in roughly 85% of cases, and about half experience headaches. Gastrointestinal symptoms like nausea, vomiting, and diarrhea affect around 50% of people, particularly children. Some patients develop a skin rash (about 25%) or ear inflammation (about 25%). In roughly 10% of males, the infection causes testicular pain and swelling.
This wide range of symptoms makes sense when you consider that enteroviruses don’t confine themselves to one part of the body. They circulate through the bloodstream and can irritate multiple organ systems at once.
How It’s Diagnosed
There’s no single definitive test that quickly confirms pleurodynia. Instead, diagnosis is largely clinical, meaning your doctor pieces it together from your symptoms, the time of year, and by ruling out more dangerous causes of chest pain.
Because the pain can closely mimic a heart attack, pulmonary embolism (a blood clot in the lung), or pneumonia, you can expect standard workups for those conditions first. That typically means an electrocardiogram, chest imaging, and blood tests. When those come back normal and the symptom pattern fits (sudden chest pain plus fever plus a viral illness during enterovirus season), pleurodynia becomes the likely diagnosis. Blood or stool samples can sometimes confirm the specific virus, but results often come back after the illness has already resolved.
Treatment and Recovery
Pleurodynia is a self-limiting illness, which means it runs its course without antiviral treatment. There’s no targeted medication that kills the virus. Management focuses entirely on controlling pain and staying comfortable. Over-the-counter anti-inflammatory pain relievers and rest are the main tools. Applying heat to the affected area and avoiding movements that aggravate the pain can also help.
Most people recover within one to four days, though some cases drag on for several weeks, and rare instances have lasted as long as 45 days. One frustrating feature of pleurodynia is that relapses are common. You might feel better for a day or two, only for the pain and fever to return. This on-and-off pattern can repeat several times before the illness fully resolves, but recovery is ultimately complete.
Possible Complications
For most people, pleurodynia is unpleasant but harmless. However, the same enteroviruses that cause it can occasionally trigger inflammation in other parts of the body. The most notable complications include pericarditis (inflammation of the sac around the heart), aseptic meningitis (inflammation of the membranes surrounding the brain and spinal cord), and orchitis (testicular inflammation) in males. In newborns, these viruses have been linked to myocarditis, a serious inflammation of the heart muscle itself.
These complications are uncommon but worth being aware of. If you develop new symptoms like a severe headache with neck stiffness, chest pain that feels different from the original muscular pain, or significant testicular swelling, those warrant prompt medical attention. In the vast majority of cases, though, pleurodynia resolves completely without lasting effects.