Crowned dens syndrome combined with cervical disc herniation: A case report and literature review.

RATIONALE: Crowned dens syndrome (CDS) is an unusual and frequently underdiagnosed cause of intense neck pain in older people due to the lack of awareness. The clinical presentation often mimics intracranial infections, which may result in unnecessary invasive procedures and the inappropriate use of antibiotics. The patient had a long-standing history of chronic neck pain, and the acute exacerbation was initially misdiagnosed as cervical disc herniation with suspected intracranial infection before the diagnosis of CDS was established.

PATIENT CONCERNS: We report the first case of an 80-year-old female patient who presented with severe suboccipital neck pain for 10 days, accompanied by restriction of rotational movement of the neck and low-grade fever.

DIAGNOSES AND INTERVENTIONS: Differentiating CDS from other potential causes of neck pain, such as degenerative cervical spondylosis, fracture, or metastatic spinal tumors, is challenging given the patient's history and clinical presentation. Initially, the patient was diagnosed with cervical spondylosis. However, treatment with pain-relief patches, acupuncture, and physiotherapy did not alleviate these symptoms. Diagnosis of intracranial infection based on laboratory tests and clinical symptoms cannot be ruled out. However, the antibiotics had no effect. Plain cervical computed tomography revealed typical calcification around the odontoid process. Increased levels of inflammatory markers can contribute to the final diagnosis of CDS. Radiography of the knee joints revealed calcium deposits in the cartilage and ligament tissues, with no apparent alteration, deformity, or destruction of the joints. This finding supported the diagnosis. After combined administration of celecoxib, colchicine, and a short course of corticosteroids, the patient's fever subsided rapidly, and both neck pain and restricted cervical mobility improved significantly. Inflammatory markers, including C-reactive protein and erythrocyte sedimentation rate, decreased rapidly and were within normal limits within 7 days.

OUTCOMES: There was no indication of recurrence, and C-reactive protein and erythrocyte sedimentation rate levels returned to normal at the 2-week follow-up.

LESSONS: CDS should be considered in cases of acute pain in the neck or occipital regions. Moreover, prompt computed tomography of the cervical vertebrae may guide early diagnosis and avoid unnecessary invasive procedures or administration of antibiotics.