Rhodes Sloan V, Nawabi Noah L A, Saway Brian F, Triano Matthew J, Varma Abhay K
College of Medicine, Medical University of South Carolina, Charleston, South Carolina.
Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.
J Neurosurg Case Lessons. 2025 Apr 28;9(17). doi: 10.3171/CASE24891.
Mycobacterium abscessus, a rapidly growing nontuberculous mycobacterium, is known for its resistance to standard antimicrobial therapies and its association with pulmonary and soft tissue infections, particularly in immunocompromised patients. Spinal infections caused by M. abscessus are rare, with limited reported cases, especially in immunocompetent individuals.
The authors report the case of a 76-year-old male who developed a deep-seated M. abscessus infection following lumbar spinal fusion surgery. Despite an initial postoperative recovery, the patient experienced progressive symptoms requiring multiple surgical washouts, removal of spinal hardware, and prolonged multidrug antibiotic therapy. Diagnostic challenges were compounded by the organism's resistance and the emergence of a possible underlying lymphoproliferative disorder. Comprehensive microbiological testing, including acid-fast bacilli cultures, identified the pathogen and guided targeted therapy.
This case highlights the diagnostic and therapeutic complexities of managing multidrug-resistant pathogens like M. abscessus in postoperative settings. Early microbiological testing, multidisciplinary collaboration, and individualized treatment strategies were critical to the patient's recovery. Additionally, the present case underscores the need for vigilance in identifying atypical infections and potential immunological dysregulation in postoperative patients. Further research is essential to refine prevention and management approaches for rare and challenging infections. https://thejns.org/doi/10.3171/CASE24891.
脓肿分枝杆菌是一种快速生长的非结核分枝杆菌，以对标准抗菌疗法耐药以及与肺部和软组织感染相关而闻名，尤其是在免疫功能低下的患者中。由脓肿分枝杆菌引起的脊柱感染很罕见，报道的病例有限，尤其是在免疫功能正常的个体中。
作者报告了一例76岁男性患者，该患者在腰椎融合手术后发生了深部脓肿分枝杆菌感染。尽管术后初期恢复良好，但患者出现了进行性症状，需要多次手术冲洗、取出脊柱内固定器械以及长期使用多种抗生素治疗。该病原体的耐药性以及可能存在的潜在淋巴增殖性疾病的出现使诊断面临更大挑战。全面的微生物学检测，包括抗酸杆菌培养，确定了病原体并指导了针对性治疗。
该病例凸显了在术后环境中管理像脓肿分枝杆菌这样的多重耐药病原体的诊断和治疗复杂性。早期微生物学检测、多学科协作和个体化治疗策略对患者的康复至关重要。此外，本病例强调了在术后患者中识别非典型感染和潜在免疫调节异常时保持警惕的必要性。进一步的研究对于完善罕见且具有挑战性感染的预防和管理方法至关重要。https://thejns.org/doi/10.3171/CASE24891 。
