A Rare Case Report: Mycobacterium abscessus in Central Nervous System Infections in Astrocytoma Patient

Mycobacterium abscessus (MAB), a rapid growing nontuberculous mycobacterium (NTM), is an emerging pathogen mostly associated with pulmonary disease, while central nervous system (CNS) involvement remains rare and has a poor prognosis. We present a case of CNS infection caused by MAB associated with a ventriculoperitoneal (VP) shunt in an astrocytoma patient. A 21-year-old male patient, pilocytic astrocytoma with noncommunicating hydrocephalus, presented with an exposed VP shunt due to wound dehiscence. Microbiological examination of cerebrospinal fluid and shunt components, confirmed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry, identified MAB. Despite initial empirical antibiotic therapy, the patient showed no clinical improvement. Intrathecal and systemic amikacin therapy was subsequently administered, resulting in transient clinical stabilization. The infection persisted despite combined medical and surgical treatment, ultimately resulting in death. MAB CNS infection presents considerable diagnostic and therapeutic challenges due to its rarity, ambiguous clinical presentation, biofilm formation on medical devices, and intrinsic antimicrobial resistance. Management requires a combination of prolonged multidrug therapy and removal of infected device. This case highlights the importance of early recognition of NTM infections in postneurosurgical patients and underscores the need for improved therapeutic strategies for this highly resistant pathogen.