SHM Converge Scientific Abstract ePoster Gallery-Painful Lies the Crown

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This case study describes Crowned Dens Syndrome (CDS), a rare form of calcium pyrophosphate dihydrate deposition disease (CPPD, or pseudogout) in which crystals deposit around the odontoid process and atlantoaxial joint, causing inflammation. CDS typically affects adults over 60 and presents with acute severe neck pain, stiffness, fever, and elevated inflammatory markers. CT imaging is the key diagnostic test because it can reveal the characteristic “crown-like” calcification around the dens.<br /><br />The report focuses on an 80-year-old man with coronary artery disease, hypertension, and osteoarthritis who developed sudden severe posterior neck pain and marked limitation of motion. He had elevated ESR, CRP, and leukocytosis, but normal uric acid and CPK. Initial CT, MRI, and vascular imaging ruled out infection, stroke, abscess, and other major causes. Because of concern for meningitis and myositis, he initially received antibiotics and prednisone, but his symptoms did not improve.<br /><br />As his pain worsened and other diagnoses became less likely, rheumatology reviewed the imaging and identified pannus and calcification around C1/odontoid process, consistent with CDS. He was then treated with anakinra (an IL-1 receptor antagonist), prednisone, and cyclobenzaprine, with significant improvement and discharge by day 7.<br /><br />The case emphasizes that CDS should be considered in older adults with acute neck pain, stiffness, and inflammatory markers, especially when infection or neurologic disease is suspected but not confirmed. Recognizing the CT findings can prevent unnecessary procedures such as lumbar puncture and prolonged antibiotics, allowing timely treatment and symptom relief.

Asset Subtitle

Sanjana Kannikeswaran

Meta Tag

Author List Adnan Beydoun, Sanjana Kannikeswaran

Category Clinical Vignettes

Concept Crowned Dens Syndrome

Concept Calcification

Concept Computed Tomography

Concept Upper Neck Pain

Concept Dens

Distinguished Finalist

Presenter Organization University of Michigan

Presenting Author Sanjana Kannikeswaran

Track Adult

Keywords

Crowned Dens Syndrome

CPPD

pseudogout

odontoid process

atlantoaxial joint

acute neck pain

CT imaging

calcification

anakinra

inflammatory markers

Crowned Dens Syndrome

Calcification

Computed Tomography

Upper Neck Pain

Dens