Abstract
BACKGROUND: 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. OBSERVATIONS: 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. LESSONS: 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.