Treatment limited for pain of rare 'devil's grip'

I read your response to the person with recurrent severe chest pain episodes and cough, who ended up in the emergency department several times over two years.

My 26-year-old son had these symptoms for nearly two years as well, on average every two months. He got them following a chest infection, and has had many trips to the emergency department. The pain is sudden, severe and radiates up the left side of his chest wall into his shoulder. Tramadol and Ibuprofen sometimes work, but a few times the pain has been severe enough to need emergency treatment. He has had every test imaginable including EEGs, ECGs, echocardiograms, countless blood tests, and even saw a psychiatrist as the hospital staff thought it could be psychosomatic. He wasn't impressed with that, as the pain is real and excruciating. He was finally diagnosed with Bornholm's disease, otherwise known as the "devil's grip", caused by the Coxsackie B virus. It is known to occur mostly in people under the age of 30, and there is no known cure.

I wanted to let you know about this disease as it is rare and often misdiagnosed. It's frightening for the patient, and also frustrating when doctors continue to question the diagnosis. - Mum

Thanks for your letter. I deal with non-cardiac chest pain every day in the emergency department, but I hadn't heard the eponym Bornholm's disease before. It's one of the causes of pleurodynia, or chest pain arising from the lung's outer lining. Pleurodynia actually has a multitude of causes, ranging from viruses to auto-immune diseases to trauma.

Unfortunately, the treatment is largely the same: anti-inflammatories such as Ibuprofen, various pain medications and the tincture of time.

Bornholm's disease, according to the books, usually occurs with fever and a cough, is generally accompanied by severe chest pain attacks lasting one to three days, and almost always resolves in a month.

But there are always exceptions to every rule, and your son may be one. The virus that causes it, Coxsackie B, lives in the intestines and passes to new victims through poor handwashing or contaminated food.

The virus attacks the muscles between the ribs, killing the cells and causing inflammation.

Attacks are described as remarkably painful and sudden but, on the bright side, even the worst cases seem to go away with time.

One brief aside regarding psychosomatic illness: it's common and often presents with unusual symptoms that defy diagnosis, and causes very real pain to the people suffering from it.

If doctors don't consider it, they'll never get it diagnosed correctly.

So please don't be put off if your doctor asks about it, or about other diagnoses such as depression - they're trying to do the right thing.

Best wishes for your son's complete recovery.

Gary Payinda MD is an emergency medicine consultant in Whangarei.

If you have a science or health topic question you'd like addressed, email drpayinda@gmail.com

(This column provides general information and is not a substitute for the advice of your doctor.)