Failure of treatment for chronic Mycobacterium abscessus meningitis despite adequate clarithromycin levels in cerebrospinal fluid

We report a case of posttraumatic meningitis due to Mycobacterium abscessus , treated initially with oral clarithromycin and intravenous amikacin plus intrathecal amikacin. Despite cerebrospinal fluid (CSF) levels of clarithro mycin and amikacin in excess of their in vitro minimum inhibitory concentra tions for the organism, the CSF cultures remained continuously positive for M. abscessus. To our knowledge, this is the first documented case of M. ab scessus meningitis and the first report of measured CSF levels of clarithro mycin in a patient with meningitis, showing that even therapeutic CSF level s of clarithromycin and amikacin might not be successful in eradicating M. abscessus meningitis.