J Rheum Dis.  2016 Apr;23(2):122-124. 10.4078/jrd.2016.23.2.122.

Acute Pseudogout of the Neck: "Crowned Dens" Revisited

• Lee H
• Kim HS
• Jung UH
• Kwon HH
• Lee YH
• Park SH

• KMID: 2222789
• DOI: http://doi.org/10.4078/jrd.2016.23.2.122

Abstract

Calcium pyrophosphate dihydrate crystal deposition disease is associated with an acute mono- or pauciarthritis, termed "pseudogout" in elderly patients, involving a large joint (including the knees, ankles) or a chronic arthropathy manifesting as mild joint pain and stiffness. Pseudogout is a crystal-deposition disease of peripheral joints, usually encountered in elderly patients. However, acute presentation of pseudogout around the odontoid process comprises a "crowned-dens" appearance, and requires contemplation of differential diagnoses. We recently experienced a case of pseudogout in the cervical spine presenting with fever and acute neck pain that was successfully treated with a colchicine and low-dose oral steroid. We reported this case with a review of the relevant literature.

Keyword

Pseudogout; Cervical

MeSH Terms

Aged
Arthralgia
Calcium Pyrophosphate
Chondrocalcinosis*
Colchicine
Diagnosis, Differential
Fever
Humans
Joints
Knee
Neck Pain
Neck*
Odontoid Process
Spine
Calcium Pyrophosphate
Colchicine

Figure

• 

  Figure 1. Axial (A) and sagittal (B) image of the cervical computed tomography scan at the C1/C2 level shows curvilinear calcifications of the transverse ligament (arrows).

• 

  Figure 2. Sagittal fat-suppressed T2-weighted (A), and T1-weighted gadolinium enhanced (B) magnetic resonance image shows a soft tissue edema and diffuse enhancement around the dens, suggesting inflammatory change.

• 

  Figure 3. By the aspiration of synovial effusion of left knee joint, square, rhomboid-shaped crystal was founded under polarized light microscope (×200).

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