Infection in glaucoma drainage implant caused by macrolide-resistant Mycobacterium abscessus subsp. abscessus

We report a rare case of Mycobacterium abscessus infection following Ahmed glaucoma valve (AGV) implantation in a 74-year-old immunocompetent man with exfoliative glaucoma. He developed conjunctival dehiscence and aqueous leakage, requiring AGV removal and re-implantation in a different quadrant. On postoperative day 27, purulent discharge appeared, prompting emergency explantation. M. abscessus subsp. abscessus was identified by culture and multiplex polymerase chain reaction, which detected the inducible macrolide resistance gene erm(41). Initial intravenous and oral multidrug therapy was discontinued due to patient preference. Infection recurred, requiring surgical debridement and prolonged therapy with amikacin, clofazimine, and sitafloxacin based on susceptibility results. This case underscores the diagnostic and therapeutic challenges of AGV-associated M. abscessus infection, which may occur in immunocompetent hosts. The organism's ability to form biofilms and resist multiple antimicrobials-especially through inducible macrolide resistance-complicates treatment. Early removal of infected devices and susceptibility-guided antimicrobial selection are essential for infection control.