髄膜炎を疑ったcrowned dens syndromeの1例

Crowned Dens Syndrome Mimicking Suspected of Being Meningitis. Case Report

　Crowned dens syndrome(CDS)の1例を経験した．症例は77歳の女性で，頚部痛および発熱を主訴に当院を受診した．症状および検査所見から髄膜炎を疑い，抗生剤の投与を行ったが症状の改善を認めなかった．頚椎CTで歯突起周囲の石灰化を認めたためCDSと診断し，ジクロフェナクナトリウムを投与し症状の改善を認めた．CDSは環軸椎歯突起を取り囲む十字靱帯の環椎横靱帯へのcalcium pyrophosphate dihydrate結晶の沈着が起こる疾患であり，頚椎単純CTで歯突起周囲の石灰化所見が特徴である．頚部痛および発熱を主訴とする，特に高齢女性はCDSの存在を念頭に置いて診察，検査および治療を行うべきである．

　We report a case of crowned dens syndrome (CDS) in a 77-year-old woman who came to our hospital with a chief complaint of neck pain and fever.　Meningitis was suspected based on her symptoms and test findings, and antibiotics were administered, but her symptoms failed to improve.　A diagnosis of CDS was made based on detection of calcification around the dens on CT scans of the cervical spine, and treatment with diclofenac sodium resulted in improvement of the patient's symptoms.　CDS involves deposition of calcium pyrophosphate dihydrate crystals in the transverse ligament of the atlas and the cruciate ligament of the atlas, which surrounds the dens, and it is characterized by the finding of calcification around the dens on plain CT scans of the cervical spine.　The possibility of CDS should be considered in the examination, testing, and treatment of elderly patients, particularly elderly women, who present with a chief complaint of neck pain and fever.