Purpose: The association between non-tuberculous mycobacterial pulmonary disease and achalasia, although previously documented in the literature, is not well recognized generally. We report a case of achalasia associated with Mycobacterium Chelonae pneumonia. Methods: A 42 year old African American female presented to our emergency department with breathlessness, fever, nausea, and vomiting. Further work up confirmed that she had multilobar pneumonia with sepsis. Five weeks prior, she was treated at another facility for community-acquired pneumonia with clinical improvement and discharge. During that hospitalization, she was also diagnosed with achalasia of the esophagus and treated with esophageal savary dilation. Her sputum at that time showed acid fast bacilli and treatment for pulmonary tuberculosis was initiated with rifampin, isoniazid, pyrazinamide, and ethambutol. Shortly after admission to our hospital, Mycobacterium Chelonae was confirmed from outside culture of bronchial washing. An EGD and esophageal manometry confirmed the diagnosis of achalasia. Post-pyloric enteral feeding was initiated. Treatment was initiated with clarithromycin, ciprofloxacin, and amikacin. Laparoscopic Heller myotomy was performed. The patient completed two weeks of intravenous amikacin and was discharged on oral ciprofloxacin and clarithromycin. She continued to do well at follow up. Results: Achalasia and lipoid pneumonia have been identified as risk factors for pneumonia caused by rapidly growing mycobacteria. Mycobacterium chelonae is a rarely identified infectious complication of achalasia. The most common clinical features are fever and shortness of breath. The most common radiographic abnormalities are unilateral or bilateral patchy dense infiltrates. The sputum is the most common source of isolation of the rapidly growing mycobacteria chelonae. It is suspected that achalasia creates a favorable mileau for the growth of mycobacterium chelonae although this has not been proven. It is unlikely that mycobacterium chelonae itself causes esophageal motility disturbance. In this case, combined antibiotic therapy and surgical treatment of achalasia was a successful treatment strategy. Conclusions: This case illustrates the need for increased awareness of this association between mycobacterium chelonae and achalasia. Treatment of achalasia might prevent recurrence and facilitate recovery from these infections.