Chronic Meningitis from Mycobacterium Fortuitum after Spinal Surgery: Systematic Review of the Literature and a Case Report

Abstract Background Post-neurosurgical meningitis is a serious complication, often associated with cranial or spinal surgeries involving implanted devices. Although post-neurosurgical meningitis is typically caused by Gram-positive bacteria, Mycobacterium fortuitum —a rapidly growing non-tuberculous mycobacterium—is increasingly reported as a rare but emerging pathogen. Methods This systematic review, conducted according to PRISMA guidelines, includes one new case and analyzes 20 previously reported English-language case reports from 1970 to April 2025. Of 48 identified studies, 21 met the inclusion criteria, focusing on confirmed M. fortuitum meningitis after neurosurgical procedures. Case Report The reported case involves a 35-year-old man who developed meningitis and a surgical site infection following lumbar spine fixation. Diagnosis was confirmed after a three-week delay due to mild, nonspecific symptoms. Management required multiple surgeries, device removal, and prolonged, targeted antibiotic therapy. After 18 months, the patient fully recovered without neurological deficits. Discussion M. fortuitum central nervous system infections are challenging to diagnose and treat, partly due to biofilm formation and antimicrobial resistance. These infections often present atypically and may not respond to standard empiric antibiotics. Early identification and individualized therapy are essential to improve outcomes and minimize long-term complications. Conclusions Clinicians should maintain a high index of suspicion for atypical pathogens such as M. fortuitum in persistent or unusual post-surgical central nervous system infections to ensure timely diagnosis and effective treatment.