Intractable Neck Pain in a Patient With Newly Diagnosed AML: An Underrecognized Cause of a Treatable Syndrome

Slostad, Jessica; Wild, Ellen; Anderson, Claudia; Ingram, Cory

doi:10.1016/j.jpainsymman.2018.10.490

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…CKD was defined as present if it was included on the problem list or clinical notes within 30 days of the index date and encompassed a range of severity, and it is possible that different stages of CKD may be associated with different risks for acute CPP crystal arthritis. Recurrent acute CPP crystal arthritis has been noted in case reports of patients with myelodysplastic syndrome (MDS) and/or acute myelogenous leukemia (AML) who have not received granulocyte colony stimulating factor (the latter of which has been linked with acute CPP crystal arthritis flares) 14,15,16 . The pathophysiology linking acute CPP crystal arthritis and MDS/AML remains unclear; it is possible that systemic inflammation related to neoplasm is a triggering factor.…”

Section: Resultsmentioning

confidence: 99%

Acute Calcium Pyrophosphate Crystal Arthritis Flare Rate and Risk Factors for Recurrence

Yates

Yoshida²,

Xu³

et al. 2019

J Rheumatol

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Objective Little is known about acute calcium pyrophosphate (CPP) crystal arthritis flare rates and risk factors for recurrence. We characterized flares and determined the rate and predictors of acute CPP crystal arthritis flares in an academic medical center cohort. Methods We performed a retrospective cohort study among a random sample of patients with acute CPP crystal arthritis identified in the Partners HealthCare electronic medical record, 1991–2017. Flare was defined as self-limited, acute-onset synovitis with synovial fluid CPP crystals and/or chondrocalcinosis, not better explained by another cause. We calculated incidence rates (IR) for acute CPP crystal arthritis flare among all subjects and by sex. We estimated HR for recurrent flare using univariate Cox models that accounted for within-person correlated data. Results We identified 70 patients with acute CPP crystal arthritis with a total of 111 flares. Recurrent flares occurred in 24% of patients; half of flares occurred in a previously unaffected joint. The acute CPP crystal arthritis flare rate was 11.4 per 100 person-years overall (95% CI 8.2–15.4), 14.2 in women (95% CI 9.6–0.1), and 7.1 in men (95% CI 3.4–13.0). Cancer (HR 2.98, 95% CI 1.33–6.68) and chronic kidney disease (HR 2.92, 95% CI 1.10–7.76) were associated with a higher rate for recurrent flare. Conclusion Recurrent flares occurred in about one-fourth of patients with acute CPP crystal arthritis and often occurred in previously unaffected joints. The acute CPP crystal arthritis flare rate was twice as high in women as in men.

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Section: Resultsmentioning

confidence: 99%

Acute Calcium Pyrophosphate Crystal Arthritis Flare Rate and Risk Factors for Recurrence

Yates

Yoshida²,

Xu³

et al. 2019

J Rheumatol

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“…While recent surgery is known to be a risk factor for CDS, no study has reported CDS development after TURP [ 1 , 12 ]. In previous studies, the occurrence of CDS after surgery included drainage of the subdural hematoma and endoscopic submucosal dissection for gastric cancer [ 5 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…In the cases of the present study, the symptoms rapidly resolved after oral administration of NSAIDs. In certain refractory cases, colchicine or a small amount of corticosteroids may be administered, but since CDS occurs mainly in older individuals, steroid therapy should be considered with caution to avoid any fatal side effects (30,43,44,53,58).…”

Section: Discussionmentioning

confidence: 99%

Report of four cases of crowned dens syndrome: Clinical presentation, CT findings and treatment

Tang

et al. 2020

Exp Ther Med

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The clinical manifestations of crowned dens syndrome (CDS) include acute neck pain and neck stiffness accompanied by restricted cervical range of motion. CDS is frequently misdiagnosed as meningitis, epidural abscess, rheumatoid arthritis, rheumatoid polymyalgia, giant cell arteritis, cervical spondylosis or metastatic bone tumor, and the incidence of CDS appears to be underestimated. The present study reported on four cases of CDS diagnosed by CT. They included one male and three females, aged from 67 to 78 years, and their major symptoms were acute neck pain and restricted cervical range of motion. Serum C-reactive protein levels and erythrocyte sedimentation rate were significantly increased in all cases. Cervical CT scan revealed calcified deposits surrounding the odontoid process in all cases. Non-steroidal anti-inflammatory drugs (NSAIDs) markedly reduced the levels of inflammatory indicators and rapidly relieved the symptoms. CT scan is considered the gold standard for CDS diagnosis, which may demonstrate calcification around the odontoid process. The patients' symptoms may be improved by treatment with NSAIDs.

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Intractable Neck Pain in a Patient With Newly Diagnosed AML: An Underrecognized Cause of a Treatable Syndrome

Cited by 5 publications

References 10 publications

Acute Calcium Pyrophosphate Crystal Arthritis Flare Rate and Risk Factors for Recurrence

Acute Calcium Pyrophosphate Crystal Arthritis Flare Rate and Risk Factors for Recurrence

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

Report of four cases of crowned dens syndrome: Clinical presentation, CT findings and treatment

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