Mycobacterium abscessus lumbar osteomyelitis: A rare and challenging case with review of literature

A 65-year-old male presented with a three-month history of back pain, increased urinary frequency and lower extremity edema. MRI spine suggested discitis/osteomyelitis at L3-L4 (Fig. 1), and blood cultures and lumbar biopsy grew gram-positive bacilli. Despite IV antibiotics, the patient continued to experience back pain. Subsequent cultures identified <i>Mycobacterium abscessus</i>. He was initially treated with IV amikacin, IV meropenem, IV tigecycline, and oral linezolid. He also underwent L3-L4 discectomy, fusion, and posterior L2-L5 fusion with drain placement. He was discharged on IV tigecycline, imipenem, amikacin, and oral linezolid, later transitioning to oral omadacycline, azithromycin, and linezolid (Table 1). This case illustrates the challenges of managing <i>Mycobacterium abscessus</i> (MAB) infections, which require a multi-drug approach due to intrinsic and acquired antibiotic resistance. Therapy should begin with in-vitro guided IV antibiotics and transition to oral drugs for the continuation phase, optimizing therapeutic efficacy and overcoming resistance mechanisms.