Journal List > J Rheum Dis > v.23(2) > 1064251

Lee, Kim, Jung, Kwon, Lee, and Park: Acute Pseudogout of the Neck: “Crowned Dens” Revisited

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.

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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).
jrd-23-122f1.tif
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.
jrd-23-122f2.tif
Figure 3.
By the aspiration of synovial effusion of left knee joint, square, rhomboid-shaped crystal was founded under polarized light microscope (×200).
jrd-23-122f3.tif
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