Background: Crowned dens syndrome is characterized by acute cervico-occipital pain, neck stiffness, fever, and classic inflammatory signs, mimicking many other diseases such as meningitis, spondylodiscitis, polymyalgia rheumatica, and giant cell arteritis. It is typically due to hydroxyapatite or calcium pyrophosphate dihydrate deposits on the ligament of the odontoid process, but sometimes it may be due to iron deposits.
Case Report: We describe crowned dens syndrome in a female patient on dialysis with well-controlled secondary hyperparathyroidism and iron overload caused by long-term iron gluconate supplementation.
Conclusions: This is the first case of crowned dens syndrome in a dialysis patient. Hemodialysis patients with cervical pain and neck stiffness should be checked with cervical CT scan to exclude this relatively unknown syndrome. Iron supplementation should be discouraged in patients with high ferritin levels because it may precipitate this rare syndrome.

Keywords: Hemodialysis, Anemia, Iron Overload, Hyperparathyroidism