# Mycobacterium wolinskyi as an emerging cause of pacemaker pocket infection and lead endocarditis: a case report and genomic characterization

## TL;DR

A case of Mycobacterium wolinskyi causing infection in a pacemaker pocket and heart is reported, highlighting the need for genomic methods in accurate diagnosis.

## Contribution

The study presents a new clinical case of M. wolinskyi infection and highlights genomic discrepancies with the reference strain.

## Key findings

- M. wolinskyi was identified in a pacemaker pocket infection and lead endocarditis.
- Genomic analysis revealed discrepancies with the reference strain, suggesting taxonomic ambiguity.
- Successful treatment involved device removal and combination antibiotic therapy.

## Abstract

Rapidly growing non-tuberculous mycobacteria (NTM) are increasingly recognized as causative agents in healthcare-associated infections. Mycobacterium wolinskyi, first described in 1999, has been associated with post-traumatic and post-operative wound infections.

We report a case of M. wolinskyi pacemaker pocket infection and lead endocarditis in a 73-year-old man, 3 weeks after implantable cardioverter-defibrillator (ICD) implantation. Initial culture from a superficial pocket swab yielded slow-growing, white colonies on chocolate agar, and the strain was identified by MALDI-TOF as M. wolinskyi. However, the 16S rRNA, hsp65, rpoB, and recA sequences were identical to those of the unofficially described M. jacuzzi species but different from the corresponding sequences of the M. wolinskyi ATCC 700010 reference strain, which showed an average nucleotide identity (ANI) of 97.49% upon whole genome comparison. Therapy consisted of ICD removal, surgical debridement of the pocket, and prolonged combination therapy with oral moxifloxacin and co-trimoxazole, with favorable clinical outcome.

This case demonstrates that our strain of M. wolinskyi could be an emerging pathogen in device-associated infections. The case highlights the diagnostic limitations of routine methods and emphasizes the role of 16S sequencing and whole genome sequencing in accurate taxonomic classification of NTM species. Broader genomic surveillance is warranted to understand the epidemiology and taxonomy of this rapidly growing NTM.