Hematogenous Dissemination of Mycobacterium abscessus Causing Pulmonary Nodules

Abstract Mycobacterium abscessus is a newly emerging nontuberculous mycobacterium (NTM) known for its multidrug resistance and rising prevalence in immunocompromised individuals. Although it frequently presents as pulmonary or soft tissue infections, bacteremia caused by M. abscessus is an uncommon manifestation. This case highlights a 63-year-old male with relapsed acute myeloid leukemia undergoing induction chemotherapy, who developed persistent fevers unresponsive to broad-spectrum antibiotics and antifungal therapy. Diagnosis was expedited using the Karius plasma microbial cell-free DNA test (KT), which detected M. abscessus 8 days before confirmation by traditional blood cultures. CT chest indicated new numerous nodules consistent with disseminated M. abscessus . Treatment involved removal of the infected PICC line and initiation of a multidrug antibiotic regimen tailored to susceptibility results. However, treatment was hindered by persistent neutropenia, antimicrobial resistance, and limited access to adjunctive therapies such as interferon-gamma due to financial constraints. This case underscores the value of next-generation sequencing in early pathogen identification and emphasizes the need to develop standardized treatment protocols for managing M. abscessus bacteremia in immunocompromised patients.