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Pulmonary infection caused by Mycobacterium abscessus is rare in children without underlying pulmonary disease, especially in infants. A 3-month-old female infant was admitted to the Third Xiangya Hospital of Central South University on July 29, 2023. Cough was her only clinical manifestation, and chest computed tomography revealed multiple patchy and mass-like high-density opacities in both lungs. Metagenomic next-generation sequencing of bronchoalveolar lavage fluid confirmed the diagnosis of Mycobacterium abscessus pulmonary disease. Further evaluation for immunodeficiency and whole-exome sequencing revealed no abnormalities. The patient improved after combination therapy with amikacin, cefoxitin, linezolid, and azithromycin, without adverse reactions. For rare pulmonary infections in infants with atypical clinical manifestations and a low positivity rate of conventional etiological tests, metagenomic next-generation sequencing may facilitate early diagnosis.