Journal of Mental Health Research and Innovation

ABSTRACT

Somatic symptom disorder is often marked by persistent physical complaints, which may be associated with an underlying organic illness, and may also be a major diagnostic concern. We present a case of a 55-year-old woman with hypothyroidism and a 25year history of intermittent generalized pain, beginning at the age of 30 years and exacerbated by a major financial stressor 3 years prior to presentation. The symptoms were pain in the upper limbs and lower back, tremors, palpitations and autonomic arousal. Orthopedic and neurologic examinations revealed only degenerative spinal changes that seemed disproportionate to her symptoms.

In September 2017 she developed sudden onset of left sided pleuritic chest pain associated with low grade fever and lymphocytosis. Extensive workup by cardiology, neurology, surgery, medicine and orthopedics ruled out major alternative diagnoses. Computed tomography of the chest showed a minimal pleural effusion. Pleural fluid analysis revealed a transudative fluid. Sputum testing for tuberculosis was negative. Virological confirmation was not available; however, the clinical presentation and exclusion of other causes led to a clinical diagnosis of suspected Bornholm disease. She was treated with corticosteroids, antibiotics, and ongoing psychiatric medications and showed marked improvement in one week.

This case emphasizes the need for detailed re-evaluation in such patients with known somatic symptoms. A multidisciplinary approach is essential to avoid diagnostic overshadowing and ensure timely recognition of organic disease.

Keywords: Somatic Symptom Disorder; Bornholm Disease; Pleurodynia; Chronic Pain; Case Report