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Volume 43, Number 6, December 2010

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

Wan-Ting Huang, Ping-Ing Lee, Luan-Ying Chang, Chuan-Liang Kao, Li-Min Huang, Chun-Yi Lu, Jong-Ming Chen, Chin-Yun Lee

Received: April 30, 2009    Revised: June 30, 2009    Accepted: August 31, 2009   


Corresponding author:

Ping-Ing Lee, Department of Pediatrics, National Taiwan University Hospital, 7 Chun-Shan South Road, Taipei 10005, Taiwan. E-mail:


Background and purpose: 

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 dis-
eases 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 infil-
trates and myopericarditis


Key words:

chest pain, coxsackievirus B3, epidemic pleurodynia, exudative tonsillitis, pleuritis