J Yeungnam Med Sci.  2023 Jul;40(3):289-292. 10.12701/jyms.2022.00388.

Crowned dens syndrome as a rare cause of anterior neck pain after transurethral resection of the prostate: a case report

• Jeong MG
• Park BS
• Son ES
• Cho JH

• KMID: 2544590
• DOI: http://doi.org/10.12701/jyms.2022.00388

Abstract

We describe the case of a 79-year-old man who presented with progressive aggravation of severe axial neck pain and fever 3 days after transurethral resection of the prostate (TURP), despite maintaining neutral neck posture during surgery. Laboratory examination revealed markedly elevated C-reactive protein levels and erythrocyte sedimentation rates. Computed tomography revealed crown-like calcifications surrounding the odontoid process. We diagnosed crowned dens syndrome (CDS) as the cause of acute-onset neck pain after TURP. The patient was treated with nonsteroidal anti-inflammatory drugs for 5 days, and his symptoms resolved completely. CDS is a rare disease characterized by calcific deposits around the odontoid process with acute onset of severe neck pain and restricted motion. Evidence of inflammation on serological testing and fever are typical of CDS. However, the prevalence and pathophysiology of CDS remain unclear. We hypothesized that systemic inflammation after prostate surgery may have induced a local inflammatory response involving calcification around the odontoid process.

Keyword

Inflammation; Neck pain; Odontoid process; Transurethral resection of prostate

Figure

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  Fig. 1. (A) Axial, (B) sagittal, and (C) coronal computed tomography scans at the C1 and C2 level demonstrate crown-shaped calcium deposits (arrows) at the posterolateral side of the odontoid process.

Reference

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