epidemic pleurodynia; Bornholm disease; epidemic myalgia; Devil's grip; Dabney's grip
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Etiology
- acute infection with Coxsackie B virus
- other nonpolio enteroviruses, including
- echoviruses type 6 & 19
- coxsackievirus A
Epidemiology
- most commonly in children < 15 years
- 50% < 5 years
- 30% < 1 year
- more common in males
Pathology
incubation period of 2-14 days
Clinical manifestations
- sudden onset of sharp epigastric rib pain
- accentuated by movement
- splinting during attacks
- duration of symptoms: several days to weeks
- upper respiratory tract symptoms
- mild pharyngitis
- rhinitis
- dry cough
- headache
- fever (morning & evening)
- pleural friction rub (25% of patients)
- transient erythematous rash (30%)
- nausea, vomiting, diarrhea (50%)
- otitis (25%)
- epigastric pain
- testicular pain (ie, orchitis) in 10% of males
Laboratory
- culture of virus from throat & feces
- serology
- positive complement fixation test
- rising titers of Coxsackie B-specific antibodies
Complications
- mortality highest in infants; 10% in 1st 4 weeks of life
Management
- no specific treatment exists
- management is supportive
- nonsteroidal anti-inflammatory drugs (NSAIDs) for pain & pleurisy (if present)
- avoid aspirin in children because of the potential to develop Reye syndrome