Concomitant fungal and bacterial atlanto-axial osteomyelitis in immunocompetent individuals is rare. We report one such patient who underwent transoral anterior decompression and posterior occipital cervical fusion, together with antibiotic and antifungal treatment. At 16-month follow-up, the patient had made a full recovery with solid fusion. Prompt diagnosis requires a high degree of clinical suspicion, with timely use of modern imaging modalities. When the diagnosis is early, antibiotic treatment alone should suffice.
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