Description

Also known as pleurodynia, Bornholm disease is an acute, transient viral myositis involving the intercostal and abdominal muscles

  • The self-limiting illness usually lasts 3-5 days and causes fever and sharp, spasmodic pain in the chest wall or abdomen
  • Associated with coxsackie B virus and most commonly seen in children and adolescents
  • Sometimes preceded by a moderate to severe headache, nausea, vomiting, and pharyngitis
  • Pleurodynia is a diagnosis of exclusion – it can mimic more serious diseases such as pneumonia, myocardial infarction and an acute abdomen which need to be ruled out

Also known as: epidemic muscular rheumatism, pleurodynia, myalgia, and myositis or eponymously as Bornholm disease, Sylvest-Bing disease, Bamble disease or just as the ‘Devil’s grip’


Epidemics

Local outbreaks with high infection rates within affected households have occurred, and major epidemics can take place every 10 to 20 years.

Numerous epidemics have been reported in the medical literature, particularly in the Scandinavian countries. Epidemic myalgia, or pleurodynia, was first recognized by Finsen in Iceland in 1856; and first published in 1872 by Daae. The first description in the American medical literature was by Dabney in 1888.


History of Bornholm disease

In 1856 and again in 1865, Jøn Constant Finsen (1826-1885) in Iceland observed outbreaks of an epidemic disease which he termed muscular rheumatism of the chest, or pleurodynia. In 1874 He published his findings as as ‘Pleurodyne‘ in his dissertation for the medical doctorate at the University of Copenhagen ‘Observations regarding the disease conditions in Iceland

Reumatisme i Brystets Muskler, Pleurodyne, antager, i Island undertiden en epidemisk Karakter. En saadan Epidemi kaldes der «taksott» d. e. Epidemi af Sting i Brystet. — Jeg har to Gange iagttaget saadanne Epidemier, nemlig i Eftersommeren 1856 og paa samme Aarstid i 1865.

Finsen 1874: 145-150

Rheumatism in the Muscles of the Chest, Pleurodyne, has been epidemic in nature in Iceland. Such an epidemic is called a “plague“, and involves painful stitches in the chest. I have twice observed such epidemics, namely in the summer of 1856 and at the same time of year in 1865.

Finsen 1874: 145-150

1872 – A. Daae recorded an epidemic occurrence of ‘acute muscular rheumatism‘ starting in Bamble, Norway on May 13, 1872 with 290 cases and incubation period of 72 hours.

As a rule the patient has a stitch in one side of the chest, most often without any precursory ailment, but sometimes after an attack of chills; the stitch is often accompanied by pains in the back, shoulders, epigastrium and abdomen and these pains are described sometimes as oppressive, sometimes as shooting or aching; less fre­quently they are felt at the back of the head, neck, arms, legs and even in the fingers. There is considerable diffi­culty in moving the affected parts, especially the chest, therefore the respiration is laboured, sometimes to such an extent that the patient feels as if he were being strangled

Daae 1872

District attorney C. Homann recorded in the same journal the series of 474 cases (346 patients out of a population 1,947 in Bamble). He recorded the epidemic to have run ‘an uninterrupted course, being transmitted by infection from patient to patient for a period of three summer months‘.

Repeated epidemics which occurred in Norway were notified in the obligatory annual reports to the Health Department under the heading ‘Bamble disease‘. Areas particularly affected have been eponymously affiliated: ‘Bamble‘, ‘Skien‘ and ‘Drangedal

1888 – On Tuesday, June 5, 1888, William C. Dabney (1849-1894), professor of obstetrics and practice of medicine in the University of Virginia, Charlottesville, recorded a case of pleurodynia, the first to be published in North America.

[The child] had been taken suddenly a few hours before with violent pain in the left side of the chest nearly over the region of the heart. His temperature was 103°F and the skin extremely hot and pungent to the touch…His chief complaint was of the pain in the chest, which was excruciating and aggravated by the slightest movement, or by drawing a long breath. Nothing abnormal could be discovered about the thoracic organs, however, on physical examination.

Dabney 1888

Dabney described 29 cases in all, and “saw at least as many more subsequently, but, being extremely busy with the final examinations of the medical students, did not take notes of them.” The Virginia epidemic was notable for its occurrence in children, including one of Dr. Dabney’s, and its familial distribution.

The pain was by far the most striking feature…In character it was usually sharp and lancinating, and was much more violent when the patient attempted to move or to draw a deep breath. (So agonizing was this pain that it was nicknamed the “devil’s grip” by a sufferer from the disease in Rappahannock County, Virginia, and this name became a common one there afterward, as I was told by Dr. W. F. Cooper.) There was slight tenderness over the seat of pain in every case, but it was not nearly so marked as the pain itself. The seat of the pain was usually in the left side of the chest just below the nipple but in some of the cases there was pain in the opposite side, or in the shoulder of the opposite side; and in a few of the cases, especially in children, there was pain in the abdomen, usually in the epigastric region

Dabney 1888

Epidemics of the disease were reported in several states of America in 1923-1925. Various names were applied to these epidemics including epidemic transient diaphragmatic spasm, epidemic pleurodynia, and epidemic diaphragmatic pleurodynia.

1930Ernst Sylvest (1880 – 1972), whilst holidaying on Bornholm Island, Denmark witnessed and described the historia morbi of 23 fisherman in Melsted and Gudhjem. He published a paper which gave the case records of his 23 patients. Sylvest considered the most prominent symptom was pain in the abdominal muscles on inspiration. He presumed the condition to be a myositis localised especially to the muscles of the upper abdominal, intercostals, chest wall and diaphragm. As far as he was aware, the disease had been described in Norway by Daae…but had no Danish name. He considered the name ‘Myositis Epidemica‘ not suitable for laymen, and suggested that in Denmark at least, the disease should be called “den Bornholmske Syge” – Bornholm disease.

1930 – Voss published a short note in the same journal as the Sylvest monograph – ‘Myositis epidemica, Bornholm disease, called Taarbæk disease 33 years ago‘. Voss had described a similar epidemic (100 cases) in Taarbæk on Zealand, Denmark in 1897. He had called the disease ‘Rheumatismus muscularis intercostalis febrilis epidemicus‘…

Following Sylvest’s description in 1930, epidemics and sporadic cases of “Bornholm disease ” were reported from all parts of the world. From 1930 to 1934 over 10,000 cases were reported from Denmark alone.

1933 – English general practitioner, Will Pickles (1885-1969) carefully recorded observations on an epidemic in Wensleydale, Yorkshire. Pickles was the first person to describe the disease in detail in Britain and noted the absence of an effective treatment, though ‘hot applications are much appreciated’. Pickles was the first to use the name Bornholm disease in British Medical reports

1948Gilbert Dalldorf and G M Sickles isolated a group of viruses associated with ‘poliomyelitis. The pair reviewed samples from two children who experienced limb weakness and were initially diagnosed with poliomyelitis in Coxsackie, a rural town in the state of New York. They made suspensions using faeces from these children and inoculated them to nursing mice, which caused the animals to die. They concluded that the virus causing this disease was different from the one causing poliomyelitis and called it coxsackievirus.

It has become desirable to name those viruses that are pathogenic for suckling mice and hamsters, and that have recently been associated with ‘poliomyelitis’…I have felt that the disease should not be named until something is known of the anatomic lesions in man…however, a provisional designation is needed and it is suggested that the agent be called ‘Coxsackie virus‘, since the’ first recognized human cases were residents of that New York village. Since a number of viruses may be involved, the term ‘Coxsackie group of viruses‘ seems especially suitable.

Dalldorf 1949

1949 – Following the isolation of the Coxsackie group of viruses, three laboratory workers contracted infections while studying it. Curnen et al, found the similarity of the patients’ symptoms to those of Bornholm disease gave rise to the speculation that the coxsackievirus might be the cause of epidemic pleurodynia.

1950 – The viral aetiology of the disease was established by GM Findlay and Elsie Howard, the agent initially isolated found to be Coxsackievirus B1.


Associated Persons

Alternative names
  • Epidemic Myalgia; epidemic pleurodynia and viral myositis
  • Norway: Bamble disease (1872), Dragendal disease (1873), Skien disease (1878)
  • USA: Devil’s grip (1888)
  • Denmark: Taarbæk disease (1897), Den Bornholmske Syge, Bornholm disease (1930); Sylvest-Bing’s disease
  • International Bornholmian disease
  • …and myriad other synonyms

Controversies

Many prior description of Epidemic pleurodynia/Myositis epidemica. Despite historical references to earlier description of the disease, the name Bornholm disease has remained…


References

Historical references

Epidemic Pleurodynia articles and outbreaks

Coxsackie articles


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eponymictionary

the names behind the name

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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