A case is presented of an immunosuppressed 51-year-old man with spondylodiscitis of the thoracic vertebrae from Mycobacterium abscessus infection, in context of disseminated multi-systemic infection with pulmonary and gastrointestinal involvement. Multiple challenges in the diagnosis and management of this confounding case are outlined. The patient underwent aggressive surgical debridement via T8–T10 vertebrectomy plus reconstruction, and right hemicolectomy to obtain source control. This was followed by prolonged combination antibiotic therapy. At time of manuscript patient is 10 months post-surgery and 18 months from initial presentation, with excellent surgical outcome and control of the infection. The unique microbiological and clinical characteristics of M. abscessus are briefly outlined. A synopsis of the relevant literature is given highlighting the relative paucity of evidence to aid management of this unpredictable infection. Current best practice guideline recommends combination of medical therapy and aggressive surgical debridement for infections caused by M. abscessus.
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