When Mycobacterium abscessus strikes: when bacteremia meets vertebral osteomyelitis

Mycobacterium abscessus is a rapidly growing nontuberculous mycobacterium that can cause a wide range of infections in humans, including skin and soft tissue infections, respiratory infections, and bloodstream infections. Although rare, bacteremia and vertebral osteomyelitis are serious and debilitating manifestations of this infection that can result in significant morbidity and mortality. In this case report, we present a case of a 68-year-old woman with a history of diabetes, hypertension, and end-stage renal failure who presented with bilateral thigh pain and fever. Four months prior to her current presentation, the patient was hospitalized for a catheter-related bloodstream infection caused by Mycobacterium abscessus. The infection was successfully managed by removing the catheter and administering a combination of antimicrobial therapy consisting of Tienem, Azithromycin, and Amikacin. A CT scan was performed, which did not reveal any abnormal foci. Surveillance cultures were negative, indicating successful treatment of the infection at that time. However, repeated blood cultures during her current admission were positive for Mycobacterium abscessus, suggestive of relapse. Further investigations including magnetic resonance imaging of her spine revealed spondylitis of the L3 and L4 vertebrae. A biopsy confirmed the presence of Mycobacterium abscessus. The patient is currently being treated with a combination of Amikacin, Tigecycline, and Azithromycin, with planned serial imaging to monitor her response to treatment. This case highlights challenges in diagnosing and treating Mycobacterium abscessus bacteremia with vertebral osteomyelitis, particularly in patients with a history of chronic medical conditions. It emphasizes the importance of early detection and appropriate management to achieve a favorable outcome. It also emphasizes the need for continued surveillance and monitoring to prevent recurrence of the infection. Clinicians should be vigilant for possible relapse, especially in patients with a history of Mycobacterium abscessus infection