Pleurisy, also known as pleuritis, is the inflammation of the pleura, the thin double layered membrane surrounding the lungs and lining the chest cavity. This condition leads to sharp chest pain, especially during breathing, coughing, or movement.

It is not a standalone disease but rather a clinical sign of an underlying condition such as infection, pulmonary embolism, or autoimmune disorders.

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What Happens in Pleurisy?

Normally, the pleural layers slide smoothly during breathing. In pleurisy:

• The pleura becomes inflamed
• Surfaces become rough
• Friction occurs during breathing
• This causes sharp, stabbing chest pain

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Causes of Pleurisy

Pleurisy can result from several underlying conditions:

Infectious Causes

• Viral infections (most common)
• Bacterial pneumonia
• Tuberculosis

Non-Infectious Causes

• Pulmonary embolism (blood clot in lungs)
• Autoimmune diseases (e.g., SLE, rheumatoid arthritis)
• Chest trauma or injury
• Lung malignancy (less common)

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Signs & Symptoms

Patients with pleurisy may present with:

• Sharp, stabbing chest pain
• Pain worsens with deep breathing or coughing
• Shortness of breath
• Dry cough
• Fever (if infection is present)
• Pleural friction rub (heard on auscultation)

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Diagnosis

Doctors may use the following tools:

• Chest X-ray
• CT scan of chest
• Ultrasound (for pleural effusion)
• Blood tests (infection/inflammation markers)
• Physical examination (pleural rub sound)

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Treatment of Pleurisy

Treatment depends on the underlying cause and includes symptom relief and targeted therapy.

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1. Pain & Inflammation Management

NSAIDs (First-line treatment)

These are the main drugs used for pain relief:

• Ibuprofen
• Diclofenac
• Naproxen

Effects:

• Reduce inflammation
• Relieve chest pain
• Improve breathing comfort

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Paracetamol (Acetaminophen)

• Used when NSAIDs are not suitable
• Provides mild to moderate pain relief
• Safe option for most patients

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2. Antibiotic Therapy (If Infection is Present)

Used in bacterial pleurisy or pneumonia-related cases:

Common antibiotics:

• Amoxicillin-clavulanate
• Ceftriaxone
• Azithromycin
• Levofloxacin

Tuberculous Pleurisy Treatment:

• Rifampicin
• Isoniazid
• Pyrazinamide
• Ethambutol

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3. Corticosteroids (Selective Use)

Used in autoimmune or severe inflammatory conditions:

• Prednisolone
• Methylprednisolone

Indications:

• Lupus pleuritis
• Rheumatoid arthritis-related pleurisy
• Severe inflammation not responding to NSAIDs

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4. Anticoagulants (If Pulmonary Embolism is Cause)

If pleurisy is caused by blood clot:

• Heparin (initial treatment)
• Enoxaparin
• Warfarin or DOACs (long-term therapy)

This is a medical emergency condition.

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5. Pleural Effusion Management

If fluid accumulates in the pleural space:

Procedures:

• Thoracentesis (fluid drainage)
• Chest tube insertion (if severe)

Medications:

• Antibiotics (if infected fluid present)
• Diuretics (in heart failure-related cases)

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6. Supportive Care

• Adequate rest
• Oxygen therapy if required
• Proper hydration
• Semi-upright positioning for easier breathing
• Breathing exercises to prevent lung collapse

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When to Seek Immediate Help

Seek emergency care if the patient has:

• Severe sudden chest pain
• Difficulty breathing
• Coughing blood
• High fever with worsening symptoms

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