SHM Converge Scientific Abstract ePoster Gallery-Unveiling the Crown: Case of Crowned Dens Syndrome Mimicking Infection

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This case describes a 95-year-old man who presented with high fevers and severe neck pain radiating to both shoulders. Because he also had elevated inflammatory markers and MRI findings suggestive of possible cervical infection, he was initially treated for a presumed soft tissue/spinal infection with broad-spectrum antibiotics. However, blood, spinal fluid, and other cultures remained negative, and he failed to improve.<br /><br />During hospitalization, he developed bilateral knee pain, and synovial fluid analysis showed calcium pyrophosphate dihydrate crystals, confirming CPPD (“pseudogout”). A cervical CT scan then revealed calcifications around the odontoid process (dens) of C2, establishing the diagnosis of Crowned Dens Syndrome (CDS), a rare spinal manifestation of CPPD. After antibiotics were stopped and systemic steroids were started, he had dramatic improvement in both neck pain and range of motion.<br /><br />The report emphasizes that CDS often affects older adults and can mimic serious infections or inflammatory conditions such as meningitis, epidural abscess, giant cell arteritis, or polymyalgia rheumatica. MRI may show nonspecific inflammatory changes and can be misleading, while CT is the preferred imaging modality because it better detects peri-odontoid calcifications. Treatment is generally anti-inflammatory therapy with corticosteroids, NSAIDs, or colchicine, and symptoms usually improve rapidly.<br /><br />The key clinical lesson is that in elderly patients with acute neck pain, fever, elevated ESR/CRP, and negative infectious workup, clinicians should consider CPPD-related spinal disease and obtain CT imaging early to avoid misdiagnosis and unnecessary antibiotics.

Asset Subtitle

Mikolaj Sulikowski

Meta Tag

Author List Mikolaj Sulikowski, Talya Bordin-Wosk

Category Clinical Vignettes

Concept Crowned Dens Syndrome

Concept Pseudogout

Concept Computed Tomography

Concept Fever

Concept Neck Pain

Distinguished Non-Finalist

Presenter Organization UCSD Health

Presenting Author Mikolaj Sulikowski

Track Adult

Keywords

Crowned Dens Syndrome

CPPD

pseudogout

acute neck pain

fever

odontoid calcification

cervical CT

elderly patient

elevated inflammatory markers

steroid therapy

Crowned Dens Syndrome

Pseudogout

Computed Tomography

Fever

Neck Pain