CDS

 Q: 64 years old male is admitted to ICU with sudden onset of severe neck pain, stiffness, and fever. CT scan of the neck reads possible "Crowned Dens Syndrome." What is Crowned Dens Syndrome? 

Answer: Crowned dens syndrome is a rheumatological disorder that mimics an acute infectious process. It is due to the deposition of hydroxyapatite crystals, or calcium pyrophosphate in the periodontoid tissues, and gives an appearance of the dens on imagings. CT scan of the neck usually shows periodontoid calcification of C1-C2, with an appearance of a crown or halo surrounding the odontoid process. 

Symptoms of CDS are fever associated with acute severe shoulder girdle and neck stiffness. Diagnosis is via elevation of acute phase reactants. Treatment is nonsteroidal anti-inflammatory drugs (NSAIDs). Colchicine works well too.

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References:

1. Aouba A, Vuillemin-Bodaghi V, Mutschler C, De Bandt M. Crowned dens syndrome misdiagnosed as polymyalgia rheumatica, giant cell arteritis, meningitis or spondylitis: an analysis of eight cases. Rheumatology (Oxford) 2004; 43:1508. 

 2.Uh M, Dewar C, Spouge D, Blocka K. Crowned dens syndrome: a rare cause of acute neck pain. Clin Rheumatol 2013; 32:711.