Mycobacterium abscessus peritonitis and ventriculitis associated with ventriculoperitoneal shunt

Area of Science:

• Infectious Diseases
• Neurology
• Medical Microbiology

Background:

• Nontuberculous mycobacteria, including Mycobacterium abscessus, are common environmental organisms.
• Mycobacterium abscessus infections are often healthcare-associated and notoriously difficult to treat.
• Treatment requires multidrug regimens and prolonged courses due to antibiotic resistance.

Observation:

• A 39-year-old female with pseudotumor cerebri and a history of ventriculoperitoneal shunt placement presented with neurological symptoms.
• Following a new shunt placement for hydrocephalus, the patient experienced clinical worsening, including confusion and echolalia.
• Intraoperative findings revealed viscous secretions on the peritoneal catheter, with cultures positive for Mycobacterium abscessus.

Findings:

• The cerebrospinal fluid and shunt fluid cultures confirmed Mycobacterium abscessus CNS infection.
• This case represents a rare instance of shunt-associated central nervous system infection caused by Mycobacterium abscessus.
• The patient's infection demonstrated characteristics of difficult-to-treat mycobacterial infections.

Implications:

• Shunt-associated CNS infections with Mycobacterium abscessus are rare and pose significant therapeutic challenges.
• Inducible macrolide resistance and inherent antibiotic resistance complicate treatment strategies for M. abscessus.
• This case underscores the need for vigilance and tailored treatment approaches for rare mycobacterial CNS infections.