Mycobacterium abscessus subsp. Bolletti-associated osteomyelitis of the lumbar vertebrae in immunocompetent patient

Abstract

Introduction: Nontuberculous mycobacteria (NTM)-related Vertebral Osteomyelitis (VO) is a rare disease with challenging diagnosis and management. NTM-caused disease more often develops in vulnerable populations, affecting individuals who are immunocompromised or who have underlying health conditions. Methods: We report a case of Mycobacterium abscessus subsp. Bolletti-associated VO in a 60-year-old immunocompetent female patient. Results: The patient presented with chronic back pain and paresis of the legs. She underwent surgery - partial resection of L4 and L5 vertebral bodies, and vertebroplasty with allograft. Culture for Mycobacterium abscessus subspace Bolletti was positive from operation material, and treatment with multiagent antibacterial therapy was started. After 2 months of treatment, an asymptomatic m.psoas abscess was identified on control imaging. Repeated surgery with abscess drainage was applied, and treatment of M.abscessus infection was continued. After a 12-month course of treatment, the patient recovered successfully and could walk without support. During treatment, she experienced a lot of drug side effects including peripheral neuropathy. Conclusion: Sampling for Mycobacterium tuberculosis and NTM should be always considered in both, immunocompromised and immunocompetent patients presenting with clinical symptoms and imaging findings consistent with VO.