Pseudogout after polyethylene glycol bowel cleansing

Crowned Dens Syndrome Occurring after Endoscopic Submucosal Dissection for Early Gastric Cancer

Crowned dens syndrome (CDS) is a rare form of pseudogout which causes acute neck pain due to calcium pyrophosphate dehydrate deposition surrounding the odontoid process, commonly causing neck pain with rigidity. While invasive procedures such as surgery are known to present a risk of acute pseudogout, reports of occurrence after endoscopic procedures are scarce. We report the case of a 75-year-old man who presented with sudden neck pain after endoscopic submucosal dissection (ESD) for gastric cancer. He could nod but could not rotate his head. Computed tomography showed calcifications surrounding the odontoid process consistent with CDS. Prolonged dietary restrictions and proton pump inhibitor use following the ESD procedure may have caused hypomagnesemia, a precipitating factor for CDS. We prescribed colchicine 1 mg/day and symptoms resolved completely in 3 days. This is the first report of CDS after ESD. CDS should be included in the differential diagnosis of neck pain after endoscopic procedures.

Crowned Dens Syndrome Associated with Bowel Cleaning for Colonoscopy

A 77-year-old man was admitted with posterior cervical pain, lumbago, a low-grade fever, and anorexia after bowel cleaning with polyethylene glycol for colonoscopy. Computed tomography of the neck showed calcification of the transverse ligament of the atlas. He was diagnosed with crowned dens syndrome (CDS). His condition improved following treatment with corticosteroids. This represents a rare case of CDS after endoscopy with polypectomy. We should consider CDS in the differential diagnosis of patients with unexplained fever and posterior cervical pain after bowel preparation for colonoscopy.

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