Crowned dens syndrome mimicking meningitis
(2023) 27th Annual Congress of the Belgian Society of Internal Medicine — Location: Dolce La Hulpe, (1.December.2023)
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- Abstract
- Introduction: Crowned dens syndrome is defined by the presence of calcium crystal deposits surrounding the dens of the axis. The main etiology of this syndrome is articular chrondrocalcinosis, a microcrystalline arthropathy characterised by precipitation of calcium pyrophosphate dihydrate crystals within cartilage and fibrocartilage. Abstract: We report the case of a 72-year-old woman admitted to the emergency department because of acute neck pain and occipital headaches followed by right inguinal pain and right shoulder pain, without fever. Her past medical history was as following: atrial fibrillation and hypertension. She was taking apixaban 5 mg b.i.d. On clinical examination, overall stiffness of cervical rachis and functional impotence of the right lower and upper limb was observed. On blood testing, C-reactive protein level was 294 mg per liter (normal value: <5). Initial diagnoses were meningitis, spondylodiscitis and retropharyngeal abscess. A lumbar puncture was not performed due to anticoagulation with apixaban. Since the patient has no fever, an infection was unlikely (without excluding totally) and a crowned dens syndrome was highly suspected and finally assessed by cervical computed tomography (CT) scan of C1/C2 showing peri-odontoid calcifications (Figure 1 and Figure 2). A treatment with corticosteroids allowed a dramatic regression of clinical symptoms and inflammatory syndrome, without recurrence when tapering and stopping steroids. Blood cultures were negative and the patient was discharge from hospital after 5 days.
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Citations
Sambon, P., Bamps, L., Douhard, S., Lecouvet, F., Yombi, J. C., & Yildiz, H. (2023). Crowned dens syndrome mimicking meningitis. Acta Clinica Belgica, 78(sup1), 1-64. https://doi.org/10.1080/17843286.2023.2278952 (Original work published 2023)