Abstract Mycobacterium abscessus is a rapidly growing, multi-drug resistant nontuberculoid mycobacteria (NTM) responsible for various infectious presentations. It is one of the most antibiotic resistant organisms within the Rapidly Growing Mycobacterial (RGM) complex. M.abscessus can become disseminated in immunocompromised individuals, however bacteremia is rare. Sarcoidosis patients are often on systemic steroids for therapy, increasing their risk for atypical infections. We present an unusual case of Mycobacterium abscessus bacteremia secondary to Sarcoid-ILD. A 71-year-old male with Sarcoid-related ILD presented for worsening hypoxic respiratory failure. The patient presented hypotensive and in shock requiring 3 vasopressors and hypoxemic requiring high-flow-nasal-cannula. He was admitted to the ICU for hypovolemic shock secondary to adrenal crisis and started on broad spectrum antibiotics for presumed pneumonia and stress steroids. His pressor needs resolved, and oxygen requirements decreased to 6L NC before ICU downgrade. The hospital course was complicated with repeat ICU upgrades for lactic acidosis and hypoxia. Initial infectious workup was negative, however persistence of hypoxia led to concern for sarcoidosis exacerbation or new infection. Repeat infectious workup including CT chest revealed new diffuse ground-glass opacities concerning for atypical infections. Respiratory panel revealed COVID-19, and blood cultures grew acid-fast bacilli favoring a rapidly growing NTM given positive cultures in less than 24hrs. The patient was started on Amikacin, Imipenem, RIPE therapy, Azithromycin and Linezolid. The patient was also started on Remdesivir and steroids. His respiratory status rapidly deteriorated requiring BiPAP, though despite this his work of breathing remained significant. Family discussions took place given the patients ongoing air hunger, high likelihood for mechanical ventilation and further decompensation. After discussion, a shared-decision was made to transition to comfort care. Final blood cultures resulted with multi-drug resistant Mycobacterium abscessus Complex. M.abscessus is a RGM commonly associated with pulmonary disease, but can cause disseminated infections such as bacteremia in immunocompromised hosts. Infection risk is heightened both by underlying immune dysfunction and frequent immunosuppressant use. Notably, opportunistic infections may occur even in untreated sarcoidosis, suggesting intrinsic immune defects beyond iatrogenic immunosuppression. Diagnosis is challenging as features between infection and sarcoidosis exacerbations can overlap. Treatment is complicated secondary to antibiotic resistance, with treatment regimens requiring multiple drugs for extended durations. Physicians should remain vigilant for Mycobacterium abscessus bacteremia in immunocompromised patients, particularly those with sarcoidosis. Prompt recognition and microbiologic confirmation are essential to distinguish infection from disease progression and guide timely, targeted antimicrobial therapy. This abstract is funded by: None
DeLuca et al. (Fri,) studied this question.