Infections caused by non-tuberculous mycobacteria (NTM) are considered emerging diseases with variable pathogenicity and are distributed in the environment. This study aims to report a case of liver abscess caused by NTM. A 64-year-old White female patient, retired and living in Campo Grande - MS. The patient underwent videolaparoscopic cholecystectomy in 2020 and, after 10 months, began having right flank abdominal pain refractory to conventional analgesics and associated with inflammatory signs in the abdominal wall with skin lesions; she was initially treated as furunculosis with partial improvement. Abdominal CT showed an intrahepatic abscess; abscess collection was performed with secretion culture positive for Staphylococcus aureus and treatment with sulfamethoxazole/trimethoprim was instituted on two occasions. In 2022, the patient progressed with significant jaundice, pruritus, and liver dysfunction, and was referred for evaluation by a liver transplant team (LT). At that service, carvedilol 6.125 mg every 12 hours and ursodeoxycholic acid 900 mg/day were prescribed, with improvement and no indication for LT. In 2024, the patient developed a painful cutaneous fistula in the right flank region, with new formation of multiple infrahepatic abscesses; local drainage was performed with 620 mL of purulent content and culture positive for Mycobacterium fortuitum. Treatment was started with amikacin for 3 months and clarithromycin and moxifloxacin for 18 months; due to the possibility of adverse reactions to the medications, the patient underwent serial audiometry and QT interval monitoring on electrocardiogram, and no significant changes were observed. In the sixth month of treatment, a new abdominal CT showed resolution of the liver abscesses. M. fortuitum is a pathogen with broad environmental distribution and intrinsic resistance to conventional antimicrobials. This case illustrates how diagnosis of an NTM infection can be difficult and time-consuming due to different clinical presentations and difficulty isolating the pathogen. In the literature, there are few cases of M. fortuitum infection, most with pulmonary and cutaneous involvement. Thus, this work demonstrates an atypical presentation with formation of liver abscesses caused by NTM in an immunocompetent patient.
Takiguchi et al. (2026) studied this question.