Rare case of pacemaker infection with Mycobacterium abscessus

Though prevalent in the environment, nontuberculous mycobacteria (NTM) have been increasingly identified as pathogenic. Sporadic reports of NTM infection of cardiac implantable electronic devices (CIEDs) have appeared but remain rare. This case describes a CIED infection with Mycobacterium abscessus, the third reported case in the literature. A 63-year-old male presented with a 3-day history of drainage from his pacemaker extraction site. An aspirate grew Mycobacterium abscessus Together with National Jewish Health, a treatment plan was developed, consisting of an induction phase with amikacin, cefoxitin and clarithromycin followed by a maintenance phase with clarithromycin and clofazimine. The clinical course was complicated by cardiac arrhythmia, abscess formation and thoracic osteomyelitis with epidural abscess. This case highlights a rare manifestation of Mycobacterium abscessus disease and suggests the need for further study. Treatment is complicated by unpredictable resistance patterns, complex antimicrobial regimens and the use of arrhythmogenic medications in patients with removed CIEDs.