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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial &#40;A&#41; and sagittal &#40;B&#41; CT images of the patient&#39;s cervical spine&#44; representing calcium pyrophosphate dihydrate crystals deposition around the odontoid process of C2 &#40;red arrows&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cervico-occipital computed tomography &#40;CT&#41; demonstrated deposition of calcium pyrophosphate dihydrate crystals around the odontoid process of axis in a 87-year-old female patient with initial diagnosis of polymyalgia rheumatica &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#44; B&#41;&#46; Patient had an acute severe cervico-occipital pain and markable neck stiffness&#46; The patient had no shoulder or pelvic girdle pain and no jaw claudication&#46; There is no history of trauma&#46; There was a long personal history of knee pain due to calcium pyrophosphate dehydrate crystal deposition disease&#46; Physical examination revealed limited passive cervical rotation without focal neurologic deficit&#46; Laboratory results revealed elevation of erythrocyte sedimentation rate of 54<span class="elsevierStyleHsp" style=""></span>mm&#47;h and a normal C-reactive protein &#40;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#46; A knee radiography confirmed peripheral calcium pyrophosphate deposition disease&#46; CT images showed atlantoaxial synovial calcifications in a crown around the odontoid process&#46; A diagnosis of crowned dens syndrome &#40;CDS&#41; or periodontoid calcium pyrophosphate dehydrate crystal deposition disease was made&#46; The patient was improved with a combination of prednisolone and nonsteroidal anti-inflammatory drug &#40;NSAID&#41; in a week&#46; CDS is a rare clinical and radiological entity described firstly in 1985 and which pathophysiologic is not completely clear&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> This condition is accompanied by acute cervico-occipital pain and stiffness with severe limitation of neck rotation&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The elevation of inflammatory markers is common&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> CDS can be misdiagnosed as various rheumatic diseases namely rheumatoid arthritis&#44; spondyloarthritis&#44; giant cell arthritis and PMR&#44; as in our case&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#44;5</span></a> For diagnosis&#44; cervico-occipital CT&#44; showing calcification around the odontoid process&#44; is the gold standard and should be done as soon as symptoms appear&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> Patients respond well to corticosteroids&#44; NSAIDs and colchicine&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> Surgical procedure is performed rarely&#46; CDS is a rare disease entity with various differential diagnosis&#46; Thus&#44; a high index of clinical suspicion is needed to obtain an early accurate diagnosis avoiding unnecessary exams or treatments&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0010" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Reumatología Clínica en imágenes
Crowned dens syndrome as a rare cause of severe cervical pain
Síndrome de Crowned Dens como causa rara de dolor cervical severo
Daniela Oliveiraa,b,c,
Corresponding author
danielasoff@gmail.com

Corresponding author.
, Carlos Vaza,b
a Rheumatology Department, University Hospital Center of São João, Porto, Portugal
b Department of Medicine of Faculty of Medicine, University of Porto, Porto, Portugal
c Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
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Article information
ISSN: 21735743
Original language: English
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Idiomas
Reumatología Clínica (English Edition)
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