Meningitis caused by Mycobacterium fortuitum

A previously healthy 16-yr-old Caucasian male developed a relapsing purulent meningitis shortly after a motor accident in Venezuela, in which he received a small wound with a retained foreign body in the sacral region. Repeated initial physical examinations, radiographs of lumbar and sacral regions, and contrast myelography failed to demonstrate a cerebrospinal fluid leak or bone involvement, and Mycobacterium fortuitum was repeatedly isolated from the cerebrospinal fluid. Finally, from the originally "cured" lumbar wound a purulent material was obtained from which M. fortuitum was also isolated. A retained foreign body was removed, and an abscess and fistulous tract were incised and drained. The patient responded dramatically to the combination of isoniazid plus co-trimoxazole and surgery.