What is the best therapy for a patient with chest pain following influenza A infection without acute findings on chest radiograph?

The best therapy for a patient experiencing chest pain following influenza A infection, especially when acute findings are not observed on chest radiograph, is indeed indomethacin. This scenario suggests the patient may be suffering from post-viral inflammation, specifically inflammatory pleuritis or pericarditis, which can sometimes occur after viral infections. Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) that is effective in reducing inflammation and alleviating pain associated with these conditions.

Indomethacin is particularly well-suited for this situation because it has anti-inflammatory properties that can relieve symptoms associated with pleuritic or pericarditic pain. Additionally, other NSAIDs like ibuprofen may also provide relief, but indomethacin has been historically used for its stronger anti-inflammatory effects in managing specific post-viral inflammatory pain.

High-dose steroids are typically reserved for cases with severe or unmanageable inflammation and would not be the first-line treatment strategy in this context, particularly when acute findings are absent. Acetaminophen, while helpful for general pain relief, does not address the underlying inflammatory process as effectively as indomethacin does in this scenario.

Thus, in managing post-viral chest pain where inflammation is presumed to be the