Bornholm disease differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz, M.B.B.S

Overview

Bornholm Disease has been referred to by various different names, some of which include Devil's Grip, epidemic pleurodynia and epidemic myalgia, to name a few. Apart from the plethora of names presenting possible difficulty in its recognition, it is often a diagnosis that is not part of the initial differential diagnosis' when a patient presents with chest pain. Because of the possibility of life-threatening conditions presenting with similar pain, it often requires extensive workup to exclude other diseases in medical settings.

Differential Diagnosis

Bornholm disease presents with acute chest and or abdominal pain and requires a high degree of suspicion for diagnosis. The disease presents with a. clinical syndrome that can appear to mimic inflammation or injury of any organ within the thorax or abdomen and thus requires differentiation.

Differential Diagnosis for Bornholm Disease

Condition	Common Presenting Symptoms	Workup to differentiate conditions from Bornholm Disease
Acute Coronary syndromes (ACS)	ACS is a spectrum of cardiac conditions that include angina, STEMI and NSTEMI. Symptoms include: Chest pain that radiates to the extremities, back or jaw Nausea, vomiting, epigastric pain Dyspnea Palpitations and sweating	Useful tests to rule out ACS include ECG and cardiac biomarkers A personal history of significant medical conditions such as hypertension, hyperlipidemia and diabetes may also assist in diagnosing the disease
Aortic dissection/ Ruptured aortic aneurysm	Severe and sudden chest pain that radiates to the extremities, back or jaw Dyspnea Syncope Upon examination, unequal blood pressure in the arms may be noticed as well as aortic regurgitation	Chest X-ray can be used to rule out aortic dissections
Pulmonary embolism (PE)	Chest pain Dyspnea Upon examination, tachycardia is a common finding	PE can be confirmed using a chest x-ray. In cases of high suspicion despite an inadequate Wells score, D-dimer can be done Conditions such as pregnancy, ongoing malignancy, a recent history of surgery or inability to ambulate may increase the risk of PE
Tension pneumothorax	Sharp chest pain Difficulty breathing Increased work of breathing Anxiety	A chest x-ray shows absent lung markings, white pleural lines, and mediastinal shift to the opposite side
Pneumonia	Chest pain Dyspnea Accompanying fever	Requires a chest x-ray to rule out pneumonia CBC findings: leukocytosis
Pleurisy/ Pleuritis	Chest pain worse on palpation and inspiration. Often radiates to the arm and or back Dyspnea	Chest X-ray can be used to rule out pleuritis ESR may also be elevated
Acute appendicitis	Periumibilical that eventually radiates to the right iliac fossa (McBurney's point) Loss of appetite Fever Nausea or vomiting	Elevated leukocyte count CT scan MRI for pregnant patients
Pancreatitis	Severe upper abdominal pain that may be worse after meals, especially those with a high-fat content, exacerbated by lying supine, radiation to the back or shoulder Nausea, vomiting, diarrhea and loss of appetite Fever / Chills	Amylase/ Lipase levels will be elevated Ultrasonography and CT scan can be helpful in diagnosis, although their use in acute conditions has been debated
Cholecystitis	Episodes of upper abdominal pain Nausea and vomiting Diarrhea	Leukocytosis Elevated CRP Elevated alkaline phosphate Hyperbilirubinemia The definitive diagnosis is with Ultrasonography. If negative, HIDA scan is done
Costochondritis	Chest pain worsened upon palpation and with movement Dyspnea	Chest X-ray ESR may also be elevated
Guillain-Barré Syndrome	Symmetrical ascending weakness and paralysis Paresthesia Areflexia	Nerve conduction studies: Axonal or demyelinating neuropathy seen in GBS; results are normal in Bornholm