Silent Crown: When Crowned Dens Syndrome Masquerades as Meningitis

We report the case of a 46-year-old female with a history of type 2 diabetes mellitus and hypertension, who presented with fever, severe neck pain, and headache.Initial investigations raised concern for meningitis or sepsis.However, normal cerebrospinal fluid (CSF) and an unremarkable brain computed tomography (CT) prompted further evaluation.A CT scan of the cervical spine revealed characteristic calcifications surrounding the odontoid process, confirming crowned dens syndrome (CDS).Corticosteroid therapy led to rapid clinical improvement and resolution of symptoms.This case highlights the importance of considering CDS in the differential diagnosis of febrile patients with neck pain, especially when preliminary investigations are inconclusive.This case illustrates how crowned dens syndrome can create a clinical picture that closely resembles meningitis and can therefore be easily overlooked during the initial assessment.The overlap in symptoms is particularly significant because both conditions may present in a similar manner.However, the distribution and character of the neck pain may provide an important clue.Severe upper cervical pain with striking restriction of neck movement, particularly rotation, should prompt consideration of crowned dens syndrome alongside infectious causes.