Introduction
Most cardiac implantable electronic device (CIED) related infections are
pocket infections and the most common organisms implicated in these are
coagulase-negative staphylococcus followed by Staphylococcus
aureus 1. Infections caused by nontuberculous
mycobacteria (NTM) are rare accounting to 0.2%, even though the
bacteria are found ubiquitously in nature2,3.Nontuberculous mycobacterium are divided into 4 groups- photochromogens,
scotochromogens, nonchromogens (these are slow growing bacteria which
take more than 2 weeks to grow in culture medium) and rapidly growing
mycobacterium (RGM) which takes 3-5 days to grow4.Mycobacterium fortuitum is one the most commonly seen RGM species
among >100 species which have been
identified2. They are capable of inducing a whole
spectrum of clinical diseases ranging from the more common prosthetic
joint/ surgical site infections to the rarely described CIED
infections5. NTM infections are emerging in previously
unrecognized settings, with new clinical
manifestations6. The most common etiology of infection
is the contamination of leads or the pulse generator during implantation
or subsequent manipulation7. Early onset CIED
infections is from direct inoculation of the organism into the pocket
whereas late onset usually results from reactivation disease,
mycobacteremia, secondary seeding of the device5.
Important risk factors may be divided into patient-related factors, such
as end-stage renal disease, procedure-related risk factors such as the
presence of hematoma among others and device related factors of which an
abdominal pocket is an important one. These risks help stratify into
high vs low risk. We present one such case of early onset mycobacterial
infection a month after a device placement in a low risk patient.