Crowned dens syndrome developed after an endoscopic retrograde cholangiopancreatography procedure

doi:10.3748/wjg.v22.i39.8849

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World Journal of Gastroenterology

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1007-9327

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Case Report

World J Gastroenterol. Oct 21, 2016; 22(39): 8849-8852
Published online Oct 21, 2016. doi: 10.3748/wjg.v22.i39.8849

Crowned dens syndrome developed after an endoscopic retrograde cholangiopancreatography procedure

Hiroyasu Nakano, Kazunari Nakahara, Yosuke Michikawa, Keigo Suetani, Ryo Morita, Nobuyuki Matsumoto, Fumio Itoh

Hiroyasu Nakano, Kazunari Nakahara, Yosuke Michikawa, Keigo Suetani, Ryo Morita, Nobuyuki Matsumoto, Fumio Itoh, Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan

Author contributions: Nakano H, Nakahara K and Matsumoto N designed the report; Nakano H, Nakahara K, Michikawa Y, Suetani K and Morita R were attending doctors for the patient; Itoh F organized the report; and Nakano H wrote the paper.

Informed consent statement: Written informed consent for endoscopic intervention was obtained from the patient and patient’s families.

Conflict-of-interest statement: Authors have no conflict of interest.

Correspondence to: Hiroyasu Nakano, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki City, Kanagawa 216-8511, Japan. bluesky0314@gmail.com

Telephone: +81-44-9778111 Fax: +81-44-9765805

Received: April 4, 2016
Peer-review started: April 4, 2016
First decision: May 12, 2016
Revised: May 26, 2016
Accepted: July 20, 2016
Article in press: July 20, 2016
Published online: October 21, 2016
Processing time: 199 Days and 2.5 Hours

Abstract

We present a unique case of crowned dens syndrome (CDS) that developed after endoscopic retrograde cholangiopancreatography (ERCP) in a patient who presented with fever and neck pain. Administration of non-steroidal anti-inflammatory drugs was extremely effective for relieving fever and neck pain, and in the improvement of inflammatory markers. To the best of our knowledge, this is the first case report of CDS caused by an ERCP procedure. In a patient with fever and neck pain after an ERCP procedure, CDS should be considered in the differential diagnosis.

Keywords: Acute cholangitis; Pseudogout; Endoscopic retrograde cholangiopancreatograhy; Crowned dens syndrome

Core tip: There are numerous differential diagnoses for patients with fever after an endoscopic retrograde cholangiopancreatography (ERCP). A careful evaluation of medical history and a physical examination provide clues to making a definitive diagnosis. Retrograde cholangitis is a well-known complication of ERCP; additionally, pseudogout is known to develop after severe illnesses or surgery. This case report describes a patient with pseudogout of the neck, which is also known as crowned dens syndrome (CDS). CDS should be considered in a patient with fever and neck pain after an ERCP procedure.