SHM Converge Scientific Abstract ePoster Gallery-Penile Prosthesis Infection With Mycobacterium Abscessus

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This case describes a fatal <strong>penile prosthesis infection caused by Mycobacterium abscessus</strong> in a 58-year-old man with prior CVA, hypertension, and well-controlled diabetes. He had traveled to <strong>India for a semi-rigid penile implant</strong> five months before presentation. About one month before admission, he developed <strong>night sweats, penile pain, scrotal swelling, and a draining wound</strong>. He was initially told he had urethral tuberculosis abroad, then presented to the hospital in New York on <strong>7/7/24</strong>.

On arrival, he was <strong>tachycardic with atrial fibrillation (rate 120)</strong> and <strong>hypertensive (195/90 mmHg)</strong>, with <strong>scrotal edema and a draining 1 cm midline wound</strong>. Labs showed <strong>leukocytosis (13,300/μL)</strong>, and ultrasound suggested a <strong>possible pyocele</strong>. He was started on <strong>piperacillin-tazobactam and RIPE therapy</strong>, with Infectious Disease and Urology consulted. Wound cultures grew <strong>Enterococcus faecalis</strong> and <strong>acid-fast bacilli</strong>; TB PCR was negative, and cultures ultimately identified <strong>M. abscessus</strong>.

RIPE therapy was stopped, and he underwent <strong>explantation of the penile prosthesis with washout</strong>, which revealed <strong>purulence, necrosis, and a urethrocorporal fistula</strong>. He was treated with multiple antibiotic regimens including <strong>azithromycin, amikacin, imipenem, tigecycline, and later linezolid</strong>, but management was complicated by <strong>acute kidney injury, QT prolongation, macrolide resistance (ERM gene), and severe tigecycline intolerance</strong>. Omadacycline was considered but was <strong>unaffordable</strong>.

Over the next four months, he developed <strong>malnutrition from inability to tolerate oral intake, recurrent AKI, DVT, falls, worsening functional status, superimposed bacterial infections, and fungemia</strong>. He ultimately <strong>died of sepsis on 12/30/24</strong>.

The case highlights the growing risk of <strong>medical tourism-related NTM prosthetic infections</strong>, the challenges of treating <strong>macrolide-resistant M. abscessus</strong>, and the need for <strong>multidisciplinary care, resistance testing, and close toxicity monitoring</strong>.

Asset Subtitle

Faye E. Reiff-Pasarew

Meta Tag

Author List Christine Stavropoulos, Elmarie Alexander, Faye E. Reiff-Pasarew, Sanah Siddiqui, Sara Huda, Thomas F. Fusillo

Category Clinical Vignettes

Concept Penile Prosthesis Infection

Concept Mycobacterium abscessus

Concept Source Control

Concept Prosthesis Explantation

Concept Macrolide Resistance

Distinguished Non-Finalist

Presenter Organization Mount Sinai Morningside

Presenting Author Faye E. Reiff-Pasarew

Track Adult

Keywords

penile prosthesis infection

Mycobacterium abscessus

medical tourism

India

semi-rigid penile implant

acid-fast bacilli

macrolide resistance

prosthesis explantation

sepsis

multidisciplinary care

Penile Prosthesis Infection

Mycobacterium abscessus

Source Control

Prosthesis Explantation

Macrolide Resistance