Abstract
The patient was a 67-year-old man who was on hemodialysis because of diabetic nephropathy and end-stage renal disease. There was a sign of infection in the subcutaneous arteriovenous fistula of the right forearm more than three weeks before he visited our hospital, and a culture test was performed three times in a nearby clinic, but all the tests showed negative results. He was urgently taken to our hospital because of neck pain during hemodialysis. After cervical computed tomography (CT) imaging in the emergency outpatient department, he suddenly experienced cardiopulmonary arrest and was resuscitated. It was determined that the epidural occupying the lesion found by cervical CT compressed the cervical spinal cord, leading to respiratory arrest. For this patient, surgery and antibiotic treatment were not possible owing to poor neurological prognosis. Blood cultures collected on the day of admission to determine the cause became positive for a bacterium on the 6th day of admission, which was identified as Mycobacteroides abscessus complex. Even rapidly growing mycobacteria require more time to grow than general bacteria, and it is difficult to detect them unless they are tested with the bacteria in mind and epidural abscesses may cause a rapid onset of irreversible symptoms. From these findings, it was considered that appropriate and prompt responses are important for such cases. If bacteria are not detected in cultures performed for the purpose of detecting general bacteria but the signs of infection persist, it is important to assume mycobacterium, perform appropriate tests, and provide information to the doctor in charge.
