This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. INTRODUCTIONCrowned dens syndrome (CDS), also known as acute pseudogout of the cervical spine, is a radioclinical entity defined by the radiographic calcifications in a crown-like configuration around the odontoid process, accompanied clinically with acute neck pain in cervico-occipital area, often with neck stiffness, fevers and raised inflammatory markers. 1 This syndrome was first described by Bouvet et al in 1985. 2 It was postulated that the crowned dens deposits could be attributed to calcium pyrophosphate dihydrate (CPPD) crystals as well as hydroxyapatite crystals. 3 The spontaneous duration of these clinical manifestations is very variable, from a few days to several weeks. These crystalline deposits, most often CPPD crystals, can remain asymptomatic or be responsible for chronic neck pains or spinal cord compression. 4 The aim of this report is to highlight CDS as an important differential diagnosis in patients presenting with acute neck pain. CASE REPORTA 79-year-old woman, known case of hypertension, present to the emergency department of our hospital with acute onset of severe posterior neck pain, occipital headache and fever. The patient also had neck stiffness, vertigo, and vomiting. She was admitted to the medical ward and neurological consultation made suspected meningitis. A computed tomography scan of the head was performed, in which serious pathology was excluded. Neurological evaluation was unremarkable, and rheumatologist opinion was sought. The patient admitted long history of neck pain, which was localized, mild, intermittent, and related mainly to activity. However, two weeks before admission, the patient developed severe posterior neck pain which was acute in onset, continuous, radiating into the occipital region, worst at night and associated with vertigo. She experienced gradual worsening of pain and marked restriction of neck

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Cutaneous vasculitis may behave as a paraneoplastic syndrome. Paraneoplastic vasculitis as a phenomenon of colonic adenocarcinoma has been described in the literature. To the best of my knowledge, this is the first case report of urticarial vasculitis being an initial presentation of signet-ring cell carcinoma of the colon. I here report a case of 27-year-old woman who had rash, arthritis, and episodic bleeding per rectum. The rash was biopsy-proven to be leukocytoclastic vasculitis. There was only partial response to high-dose steroid, and rectal bleeding continued. Colonoscopy revealed a stenosing growth of sigmoid colon, which proved to be signet ring cell carcinoma of the colon. It is important to remain vigilant with regard to the association between leukocytoclastic vasculitis and malignancies.

Thyrotoxic periodic paralysis (TPP) is a rare condition related to thyrotoxicosis seen predominantly in men of Asian Here I present a case of a 34-year-old Chinese man who presented with sudden onset weakness of his upper and lower extremities that resolved spontaneously. His investigations revealed elevated free thyroxin (FT4), free triiodothyronine (FT3), suppressed thyroid-stimulating hormone (TSH) and hypokalemia, and he was diagnosed with thyrotoxic periodic paralysis. It is important to consider the diagnosis of TTP in patients presenting with acute onset of weakness. This report reviews the literature looking at pathophysiology, clinical features, and treatment for this rare complication of hyperthyroidism.

Angioleiomyomas are benign tumors originating in the vascular smooth muscles. The tumor typically presents as a painful, solitary, small subcutaneous nodule. Herein, we have described a case report of chronic leg pain due to angioleiomyoma. We outline the clinical, radiological and histopathological features of this rare diagnosis for a painful nodule of extremity. Although rare, angioleiomyoma should be included in the differential diagnosis of chronic leg pain.