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

Acute Pseudogout of the Neck: "Crowned Dens" Revisited

Affiliations
  • 1Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. yourii99@cu.ac.kr
  • 2Department of Diagnostic Radiology, Catholic University of Daegu School of Medicine, Daegu, Korea.

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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