SHM Converge Scientific Abstract ePoster Gallery-What a Pain in the Neck! An Unsual Presentation of a Common Disease

Pdf Summary

The document describes a case of a 76-year-old woman who presented with two days of neck pain, shoulder tenderness, subjective fevers, and markedly elevated inflammatory markers, including ESR and ferritin. Because her symptoms overlapped with polymyalgia rheumatica and giant cell arteritis, she was initially diagnosed with vasculitis and treated with high-dose prednisone. However, she had little improvement.<br /><br />A later chart review, along with radiology and rheumatology reassessment, revealed the correct diagnosis: Crowned Dens Syndrome, a form of pseudogout affecting the cervical spine. Imaging showed inflammatory changes, and the patient’s history of hyperparathyroidism supported the diagnosis, since hyperparathyroidism can promote calcium crystal deposition. Additional labs showed elevated parathyroid hormone, low vitamin D, and mildly positive rheumatoid markers that could have been misleading.<br /><br />The case highlights that Crowned Dens Syndrome can present with acute neck pain, fevers, elevated ESR/CRP, and nonspecific MRI findings, making it easy to confuse with vasculitis or other inflammatory disorders. The main teaching point is to avoid anchoring and confirmation bias when a patient does not respond as expected to treatment.

Asset Subtitle

Isabel Wees

Meta Tag

Author List Isabel Wees, Stephen J. Harder

Category Clinical Vignettes

Concept Crowned Dens Syndrome

Concept Pseudogout

Concept Calcium Pyrophosphate Crystal Deposition

Concept Acute Neck Pain

Concept Inflammatory Markers

Distinguished Non-Finalist

Presenter Organization Utsw

Presenting Author Isabel Wees

Track Adult

Keywords

Crowned Dens Syndrome

pseudogout

neck pain

hyperparathyroidism

giant cell arteritis

polymyalgia rheumatica

elevated ESR

prednisone

calcium crystal deposition

confirmation bias

Crowned Dens Syndrome

Pseudogout

Calcium Pyrophosphate Crystal Deposition

Acute Neck Pain

Inflammatory Markers