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.