Epidemic Pleurodynia Caused by Coxsackievirus B3 at a Medical Center in Northern Taiwan

Abstract

Epidemic pleurodynia is seldom reported in Southeast Asia and there has been no report from Taiwan. We conducted a retrospective chart review of children = 18 years of age in the National Taiwan University Hospital from January 1 to December 31, 2005. Epidemic pleurodynia was defined as an acute illness characterized by sharp localized pain over the chest or upper abdomen. Patients with known heart diseases or pulmonary consolidations were excluded. In total, 28 patients met the case definition of epidemic pleurodynia. Coxsackievirus B3 (CB3) was isolated in 15 (60%) of the 25 throat swab specimens. Four (14%) of the 28 patients presented chest wall tenderness and only one (6%) of the 18 patients tested had an elevated creatinine kinase level. Twenty-one (75%) of the 28 patients described pleuritic chest pains and 10 (45%) of the 22 chest radiographies exhibited pulmonary infiltrates or pleural effusions. Six patients were observed with tonsillar exudates and one was confirmed to have a CB3 urinary tract infection. The clinical features and radiological findings suggest that CB3-associated epidemic pleurodynia might be a disease of the pleura and occasionally spreads to nearby tissues, resulting in chest wall myositis, pulmonary infiltrates and myopericarditis.

A case of epidemic myalgia with symptoms resembling acute purulent spondylitis and discitis

“…It is possible that the reason why acute low back pain has not been previously reported as a symptom of epidemic myalgia is that the disease was first described many years ago, which may have limited the number of further reports regarding novel symptoms. Moreover, there is low awareness regarding this disease in East Asia [7, 8]. Furthermore, this disease is difficult to recognize, and thus many cases go unreported [7].…”

“…Moreover, there is low awareness regarding this disease in East Asia [7, 8]. Furthermore, this disease is difficult to recognize, and thus many cases go unreported [7]. Finally, non-steroidal anti-inflammatory drugs are effective against epidemic myalgia pain [3].…”

Chest wall myositis in a patient with acute coronary syndrome

“…However, a few laboratory findings can aid in the diagnosis. A full blood count could show a picture of leucopenia or leucocytosis with or without elevated band cells,5 but a normal WCC is not uncommon. There are also a number of reports of elevated erythrocyte sedimentation and creatine kinase.…”

“…However, there are several reports of positive lung infiltrates with or without pleural effusion as was the case with our patient. Huang et al 5 reported that 45% of patients with Bornholm disease had positive chest radiological findings.…”

Non-Cardiac Chest Pain of Non-Esophageal Origin

“…It is also known as Bornholm disease or epidemic pleurodinia . It may cause pulmonary in fi ltrates, involve the pleura producing pleural effusions or affect the nearby tissues causing myositis of the abdominal and intercostal muscles and even myopericarditis [ 73 ] . It causes intermittent chest pain that increases with deep respiration, frequently associated with fever in young adults [ 49 ] .…”