Crowned dens syndrome (CDS) is a rare but underrecognized cause of severe neck 
pain in older adults. It is characterized by acute onset pain and stiffness of 
the cervical spine. Accompanying fever and elevated inflammatory markers often 
lead to misdiagnosis. It is frequently associated with calcium pyrophosphate 
deposition disease, hydroxyapatite crystals, and sometimes other inflammatory 
conditions. Periodontoid calcification is seen on cervical computed tomography 
(CT) scan but is not typically visible on plain radiographs, making CT scanning 
invaluable in diagnosis. We describe a case of CDS in a 59-year-old woman, who 
presented with severe neck pain, elevated inflammatory markers, and progressive 
evolution in the appearance of her CT scans. The pathophysiology, clinical and 
radiographic findings, and dramatic response to corticosteroid therapy are 
reviewed.