Improvements in the exit-site care for peritoneal dialysis (PD) patients have 
uncovered a trend for increasing incidence of rapidly growing nontuberculous 
mycobacterium exit-site infections (ESI). Among these, Mycobacterium abscessus 
is unique in terms of its high morbidity and treatment failure rates. The 
international society of PD guidelines encourage PD catheter removal in patients 
with M. abscessus peritonitis but, do not have evidence-based recommendations 
for the management of ESIs related to this organism. We report an unusual case 
in which an asymptomatic end-stage renal disease patient with multiple favorable 
clinical characteristics, i.e., no apparent immunodeficiency, sensitivity 
pattern showing possibility of treatment with multiple antibiotics, no evidence 
of peritonitis, and early clinical response, was treated with a 9-month 
combination antimicrobial regimen administered orally and intraperitoneally. 
Despite excellent clinical response with a resolution of the ESI, our patient 
relapsed quickly, within 30 days of stopping antimicrobial therapy and required 
PD catheter removal. Our case, taken together with available published case 
reports, highlights the futility of the conservative approach towards the M. 
abscessus ESI and makes the cases for early PD catheter removal in these 
patients.