An 80-year-old male presented with fever, malaise, and a painful, erythematous pacemaker pocket, leading to the diagnosis of pacemaker pocket infection and lead endocarditis. Initial cultures were negative, but subsequent 16S rRNA gene sequencing and whole-genome sequencing identified Mycobacterium wolinskyi. The patient underwent device removal and received a prolonged course of clarithromycin, moxifloxacin, and amikacin, showing clinical improvement. This case highlights the importance of considering rapidly growing non-tuberculous mycobacteria in device-related infections, especially when standard cultures are inconclusive.
Key note: Mycobacterium wolinskyi should be considered in pacemaker infections, particularly when conventional diagnostics fail to identify a pathogen.