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What a pain in the neck: Crowned dens syndrome as an uncommon cause of neck pain

Introduction: Crowned Dens Syndrome is an uncommon manifestation of calcium pyrophosphate deposition disease caused by crystal deposition and associated inflammation in the C1 and C2 area of the spine. Crowded Dens Syndrome typically causes posterior neck pain and limitation in range of motion. This report describes a case of this unusual and challenging diagnosis and its importance in the differential diagnosis of neck pain. Case Report: An 80-year-old woman presented as a transfer from another hospital for evaluation for possible epidural abscess. She noted several weeks of progressive posterior cervical neck pain. The pain was worse with passive motion, especially flexion, and she had decreased range of motion in all directions. She had elevated inflammatory markers, and neck computed tomography (CT) scan was non-diagnostic. Broad-spectrum antibiotics for treatment of a possible abscess or meningitis were initiated without improvement. After arrival at our hospital, a dual-energy CT scan concentrated at the C1–C2 area was performed. This imaging revealed multiple calcific deposits surrounding the odontoid with associated soft tissue thickening consistent with Crowned Dens Syndrome due to calcium pyrophosphate Alexander M Pandelidis1, Alan W Dow2 Affiliations: 1Internal Medicine Resident, VCU Health System, Richmond, Virginia, USA; 2Perlin Professor of Medicine and Health Administration, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA. Corresponding Author: Alexander M Pandelidis, Department of Internal Medicine, VCU Health System, Richmond, Virginia 23298-0509, USA; Email: alexander.pandelidis@vcuhealth. org Received: 02 May 2019 Accepted: 24 June 2019 Published: 20 August 2019 deposition disease. She improved with steroid treatment. Conclusion: Crowned Dens Syndrome presents similarly to infectious, malignant, and other inflammatory causes of neck pain. Because specific imaging is often necessary to make the diagnosis, clinical awareness and suspicion are essential for identifying this condition and prescribing the correct therapy.