Annie Galt
A King and his Crowned Dens: Calcium Pyrophosphate Deposition
Mentor: Santosh Reddy, MD
Department: Internal Medicine
CPPD crystal deposition is the third most common inflammatory arthritis. The crystal deposition in joints and soft tissues can present with broad spectrum clinical manifestations. Patients often have co-morbid conditions, making the diagnosis difficult. Specifically, calcification around the odontoid process causes the rare Crowned Dens Syndrome (CDS). In patients with neck pain and high clinical suspicion of CPPD, a head and neck CT may aid in diagnosis.
The patient was diagnosed with Crowned Dens Syndrome secondary to CPPD as by the American College of Rheumatology classification criteria for CPPD.
This patient with subacute onset of severe neck pain and polyarthralgia was diagnosed with CDS secondary to CPPD; despite his negative laboratory workup for inflammatory arthritis, head and neck imaging aided in making this diagnosis. Although no modifying treatments currently exist, he clinically improved with a steroid taper and daily colchicine.
