Pleurisy: Symptom or Condition?

Jennifer Confer, PharmD, BCPS; Jennifer Egbert-Kibler, PharmD

US Pharmacist

Symptoms

Depending upon the underlying cause of pleurisy, patients may present with a wide variety of symptoms. As described above, one common feature in patients with pleurisy is a pleural rub, in which the parietal and visceral pleurae rub together and cause friction. This friction, brought about by pleural inflammation, can be acute or chronic. The pain, which is sharp and localized, tends to be further intensified by coughing, sneezing, deep inspiration, or chest movement.^[1,2] A physical examination may reveal additional findings, including reduced breath sounds, wheezing, productive cough with sputum production, or rapid, shallow breathing. To accurately diagnose the cause of pleurisy, the clinician should combine a history of the patient's symptoms with a full physical examination and results of diagnostic tests.^[1–3]

1 2 3 4 5 6 7

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Table 1. Potential Etiologies of Pleurisy
Toxins	Autoimmune Disorders
Asbestos Drug-induceda	Systemic lupus erythematosus Rheumatoid arthritis Sjögren's syndrome Wegener's granulomatosis
Cardiac Pulmonary embolism Myocardial infarction Pericarditis	Gastrointestinal Inflammatory bowel disease Spontaneous bacterial peritonitis
Infectious Bacterial Viral Parasitic	Hematologic Malignancy Sickle cell disease
Respiratory Pneumonia Tuberculosis pleuritis Viral pleurisy Pneumothorax	Iatrogenic Thoracentesis Chest tube insertion Thoracotomy Pleurodesis

^a See TABLE 2. Source: References 1–4, 6–9.

Table 2. Drugs Reported to Cause Pleurisy and Pleuritic Chest Pain
Cardiovascular	Chemotherapeutic Agents
Agents	Bleomycin
Amiodarone	Mitomycin
Minoxidil	Procarbazine
Bromocriptine	Methotrexate
Methysergide	Cyclophosphamide Docetaxel
Drug-InducedPleural FluidEosinophilia	Miscellaneous Agents
Nitrofurantoin	Acyclovir
Dantrolene	Clozapine
Valproic acid	D-penicillamine
Propylthiouracil	Granulocyte colony-
Isotretinoin	stimulating factor
Sclerotherapeutic Agents Sodium morrhuate/absolute alcohol	Interleukin-2 L-tryptophan Simvastatin Mesalamine Itraconazole IV immunoglobulin

Source: References 7–9.

Table 3. Therapies for Common Conditions That Result in Pleuritic Chest Pain
Condition	Treatment
Pulmonary embolism	Anticoagulation: unfractionated heparin, LMWH, fibrinolytic therapy, warfarin
Pneumothorax	Supplemental oxygen Chest tube insertion Needle decompression Pleurodesis
Myocardial infarction (NSTEMI/STEMI)	Oxygen therapy Nitrates Analgesics Antithrombotic therapy: aspirin, clopidogrel, unfractionated heparin/LMWH, glycoprotein IIb/IIIa inhibitor Beta-blockers
Pleural effusion	Oxygen therapy Diuretics (effusion due to heart failure) Thoracoscopy Antibiotics (effusion due to infection) Chest tube insertion
Pneumonia	Antibiotic therapy Supplemental oxygen Smoking cessation
Drug-induced pleural disease	Removal of offending agent NSAIDs

LMWH: low-molecular-weight heparin; NSAID: nonsteroidal anti-inflammatory drug; NSTEMI: non–STEMI; STEMI: ST-segment elevation myocardial infarction.
Source: References 2, 3, 15, 16.

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Pleurisy: Symptom or Condition?

Symptoms

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