Bornholm disease

Named after the Danish island where an outbreak was described, it presents abruptly with fever and knife-like, spasmodic pain over the lower chest or upper abdomen, worsened by breathing, coughing, and movement, and coming in waves lasting minutes with pain-free intervals. A pleural friction rub may be heard, and the pain often prompts investigation for pulmonary embolism, myocardial infarction, or an acute abdomen. Symptoms usually settle within a week, though relapse after a few days is common. Because coxsackie B also causes myocarditis and pericarditis, patients should be assessed for those, and concurrent orchitis or aseptic meningitis may occur. Transmission is faecal-oral, with summer and early autumn outbreaks in families and communities. Diagnosis is clinical, supported by throat or stool PCR; chest imaging is normal, which helps exclude alternatives. Treatment is symptomatic with analgesia and NSAIDs, with caution if myocarditis is suspected. Recovery is complete.