Crowned Dens Syndrome Presenting as Failure to Thrive in a Patient With Moderate Cognitive Impairment.

Crowned dens syndrome (CDS) is a rare condition characterized by the deposition of calcium pyrophosphate (CPP) or hydroxyapatite crystals around the odontoid process of the C2 vertebra, often presenting with acute neck pain, reduced cervical mobility, and systemic inflammatory response. This case describes a 68-year-old male patient with a history of type 2 diabetes, hypertension, and benign prostatic hyperplasia who presented with generalized weakness and failure to thrive. This atypical presentation initially masked symptoms of CDS, delaying the diagnosis until the patient developed acute neck pain and stiffness, prompting further imaging. CT imaging revealed calcifications around the odontoid process, confirming the diagnosis of CDS. Given the severity of the symptoms, corticosteroids were administered, resulting in significant clinical improvement. This case highlights the importance of considering CDS in the differential diagnosis of older patients presenting with systemic inflammatory symptoms and unexplained neck pain, particularly when initial workups are inconclusive.