Pleurisy: Symptom or Condition?

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

US Pharmacist

Conclusion

Pleurisy is a condition in which pleuritic chest pain may evolve as a symptom secondary to a primary cause. NSAIDs (particularly indomethacin), along with opioid analgesics, remain the mainstay of treatment for pleurisy; identification and treatment of the primary cause are also important. A variety of disorders can cause pleurisy, including pulmonary embolism, pneumonia, and myocardial infarction; the condition may also be drug induced. It is imperative that life-threatening conditions be considered first when a patient presents with pleuritic chest pain.

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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?

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