Mycobacterium abscessus peritonitis and ventriculitis associated with ventriculoperitoneal shunt

Mycobacterium abscessus, like most nontuberculous mycobacteria, is a pervasive organism. It frequently presents as a healthcare-associated infection. Mycobacterium abscessus infections are notoriously difficult to treat, requiring multidrug regimens and a prolonged treatment course. The patient is a 39 year old hispanic female with a history of pseudotumor cerebri with ventriculoperitoneal shunt which had recently been removed due to concern for infection. She presented with complaints of headaches, blurry vision, nausea, vomiting, slowed speech, inability to void and difficulty with memory. One month into this hospitalization, a new shunt was placed for symptomatic hydrocephalus. She began to exhibit signs of clinical worsening with confusion and echolalia, so her shunt was removed. Intraoperatively the peritoneal catheter of the shunt was noted to have a viscous secretion around it. Cultures of this fluid and samples from the cerebrospinal fluid grew Mycobacterium abscessus. Shunt-associated central nervous system infections with Mycobacterium abscessus are rare and difficult to treat. Treatment of M. abscessus is complicated by inducible macrolide resistance and some inherent resistance to many antibiotics.