Q: My husband contracted pneumonia in early December. We believe he got it by exposure to so much corn dust at the feed mill where he was unloading corn. He was treated with ciprofloxacin and azithromycin which did clear up the pneumonia. Then he got pleurisy and also a bad sinus infection toward the end of the month. The sinus infection was treated with amoxicillin and went away but the pleurisy just hangs on. We’re treating it with NSAIDs. Any suggestions?
A: Pleurisy is inflammation of the pleura, the membrane that lines the rib cage itself and surrounds the lungs. The pleura is double-layered and both protects and lubricates the surface of the lungs as they inflate and deflate. There is a thin fluid-filled gap known as the pleural space that allows the two layers of the pleural membrane to slide smoothly past each other; however, when the layers become inflamed by sneezing, coughing or even breathing, their surfaces rub together, making breathing very painful. In some instances, excess fluid may seep into the pleural space and cause a condition known as a pleural effusion. That fluid buildup generally has a lubricating effect that relieves the pleuritic pain. However, at the same time, the fluid places additional pressure on the lungs and lessens their ability to function as they should. A pleural effusion can also occur without pleurisy because of heart failure and liver or kidney disease.
Common causes of pleurisy in an otherwise healthy individual include a viral, bacterial or fungal infection, chest injury such as a fractured rib, pneumothorax, tuberculosis, a drug reaction, rheumatoid arthritis, or disorders such as a pulmonary embolism, lupus, liver disease, and cancer. You are probably correct in that your husband’s condition was from inhaling an excessive amount of corn dust.
Symptoms are chest pain that begins suddenly and dyspnea (difficulty breathing) on one side of the chest only that may exacerbate with sudden movement, coughing or sneezing and may lessen when pressure is placed on the side the pain is on. The pain may also extend to the shoulder or back.
Diagnosis might be made through laboratory testing that can detect an infection or autoimmune disorder, a chest X-ray that will allow a radiologist to determine if the lungs are fully inflated or if air or fluids are present between the lungs and ribs, an ultrasound that could rule out a pleural effusion, computerized tomography (CT) scan that can detect the cause of the pleuritic pain, and an electrocardiogram (EKG) to rule out cardiac involvement. Your physician might order a thoracentesis to remove fluid for analysis under a microscope, or a pleural biopsy if he or she is finds sit necessary to rule out tuberculosis or cancer. Treatment will depend on the underlying cause for the pleurisy. As a general rule, a virus will resolve on its own over time, while a bacterial infection should respond to antibiotic therapy.
While you may hope for immediate results, you may be a bit premature expecting what must be a virus to resolve. If your husband fails to improve shortly, I would consider having his physician (or perhaps even a college-based veterinarian test some corn dust particles to determine just what he might have contracted. The next step would be to advance to a pulmonologist who might might bring things to light. Good luck.
