Buttock carbuncle with severe hypothermia and disturbed consciousness: when os odontoideum is the answer

Abstract Os odontoideum (OO) is an uncommon lesion of the second cervical vertebra (C2). Although the etiopathology is largely controversial, the definition is uniformly accepted to be an independent ossicle with smooth circumferential cortical margins without osseous connection to the body of C2 vertebra. Despite its debatable etiology, the diagnosis and management of which is largely irrelevant. Patient with OO can present variably with myelopathy or asymptomatic with diagnosis being made incidentally on imaging studies. Non-surgical management are currently accepted if the patient is asymptomatic and did not display atlantoaxial instability. However, surgery is indicated for patients with neurological symptoms and/or atlantoaxial instability. We present a case of 59-year-old male who was brought to emergency department by family with consciousness disturbance, hypothermia, and buttock carbuncle initially suspected to be septic shock with later diagnosis of unstable os odontoideum related cervical spine injury.