Difficulty in diagnosis and management of musculoskeletal nontuberculous mycobacterial infections

We describe two cases of musculoskeletal nontuberculous mycobacterial (NTM) infection resulting in undesirable outcomes. These organisms can be difficult to identify and treat, potentially leading to significant morbidity. NTM should remain on the differential for culture negative bone and joint infections, especially with a prior surgical history or environmentally-acquired injuries. •There is considerable difficulty in diagnosing NTM orthopedic infections.•These infections can be prolonged and progressive.•Consider NTM infection with negative cultures and failure of routine antibacterials.•Surgical debridement is essential in combination with antimycobacterials.•Treatment should be determined after culture results yield drug susceptibilities.