A 55-year-old female presented with altered mental status and hydrocephalus. She had blunt head trauma associated with subarachnoid and intraventricular haemorrhage. A head computed tomography scan showed blood in occipital horns bilaterally and increased ventriculomegaly of the lateral, third and fourth ventricles. An EVD was placed at the bedside. She subsequently developed worsening altered mental status, fever and tremors with rising serum white blood cell count. Cerebrospinal fluid (CSF) was obtained from the EVD on day 5 as part of initial work up that showed pleocytosis and hypoglycorrhachia. CSF studies were repeated 5 days later and revealed worsening parameters despite empiric antibiotics.
Gram stain showed gram-positive bacilli and acid-fast stain was positive. CSF was analysed at the Indiana University microbiology laboratory via Mycobacteria Growth Indicator Tube (MGIT) liquid media while Nucleic Acid Amplification Testing (NAAT) was negative for  Mycobacterium tuberculosis . Growth on solid media using Middlebrook 7H10 agar was observed and matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) MS identified the rapidly growing non-tuberculous  M. mucogenicum . Parenteral therapy with amikacin 1 g every 24 h, cefoxitin 2 g every 6 h, and sulfamethoxazole-trimethoprim 15 mg kg-1 day-1 in three divided doses was initiated. The EVD was replaced and 4 weeks later a ventriculoperitoneal shunt was placed when repeated CSF studies were markedly improved (Table 1). The patient's neurological exam improved and was nearly back to baseline 6 weeks later.