A Neck of Deception

What do a fever, stiff neck and leukocytosis have in common with a large swollen knee? Listen to this medical mystery to see if you can figure out the diagnosis, then stick around to hear interesting information you may not know about the disease, including historical perspectives.  

• Intro :10
• A 71-year-old man presents with unilateral knee swelling, fever and neck stiffness :37
  • Medication overview 2:12
  • Physical exam findings 2:24
  • Laboratory findings 3:03
  • Imaging results 3:33
  • Rheumatology consult 4:30
  • Now what? 5:08
  • CT scan is ordered 6:04
  • The meningitis mimicker 6:24
• History of pseudo-gout 6:54
• What do we know about chondrocalcinosis? 7:53
• History of Crowned Dens syndrome 9:37
• Cervical spine anatomy review 11:05
• Data from a single center 12:40
• Can this be dangerous? 13:40
• Are we sure this is pseudo-gout? 14:20
• The role of the CT in the diagnosis of this case 14:50
• Treatment options 15:44
• "Why not treat the patient with steroids from the start?" 16:12
• Email me with questions, or if you know any cases of hydroxyapatite-induced Crowned Dens 16:39

We'd love to hear from you! Send your comments/questions to [email protected].

References:

Ali S, et al. J Radiol Case Rep. 2011;doi:10.3941/jrcr.v5i8.802.

Bouvet JP, et al. Arthritis Rheumatism. 1985;28:1417-20.

Ciricillo SF, Weinstein PR. J Neurosurg. 1989;71:141-143.

Goto S, et al. J Bone Joint Surg Am. 2007;89:2732-2736.

Marson P, Pasero G. Reumatismo. 2012; 63: 199-206.

Salaffi F, et al. Clin Exp Rheumatol. 2008;26:1040-1046.