Background: Nontuberculous mycobacteria (NTM) are emerging pathogens associated with diverse infections. Among them, Mycobacterium abscessus is a rapidly growing, multidrug-resistant species with notoriously poor treatment outcomes. Vertebral osteomyelitis due to NTM remains rare, often leading to diagnostic delay and mismanagement.

Case Report: We report the case of a 65-year-old Indian male presenting with chronic back pain, weight loss, and subsequent spinal instability. Despite empirical anti-tubercular therapy for presumed Pott’s disease, the patient developed persistent discharging sinuses and worsening spinal involvement. Cultures eventually identified M. abscessus, with drug susceptibility testing guiding a multidrug regimen of intravenous and oral agents. Clinical improvement was achieved with a multidisciplinary approach.

Conclusions: This case underscores the diagnostic challenges of NTM spinal infections, the therapeutic difficulties due to drug resistance and adverse effects, and the urgent need for NTM-specific management protocols in tuberculosis-endemic countries.