Case Report: Disseminated Mycobacterium abscessus subsp. bolletii infection with central nervous system involvement in acquired anti-IFN-γ autoantibody syndrome

Acquired Anti-interferon (IFN)-γ Autoantibody Syndrome (AAS) is an emerging immunodeficiency predisposing to disseminated nontuberculous mycobacterial infections. We report a 51-year-old woman with AAS presenting with Sweet's syndrome, disseminated <i>Mycobacterium abscessus</i> subsp<i>. bolletii</i> infection, and central nervous system (CNS) involvement manifested as leptomeningeal enhancement despite sterile cerebrospinal fluid. Diagnosis was confirmed by serum anti-IFN-γ autoantibody titer >1:10,000 and lymph node culture. The patient achieved sustained remission through a staged approach: 26 months of tailored antibiotics (imipenem/ceftazidime/amikacin/clarithromycin-based regimen) followed by delayed cyclophosphamide immunotherapy. This case highlights the importance of anti-IFN-γ autoantibody screening in disseminated infections and demonstrates that CNS involvement may occur without typical cerebrospinal fluid abnormalities. Our management strategy-prioritizing infection control before immunosuppression-provides a pragmatic framework for resource-limited settings.