Unmasking Mycobacterium chelonae: A Rare Case of Graft Pyelonephritis and Triumph Beyond Illness

Introduction: Rare yet formidable,Non Tuburculous Mycobacterial(NTM)infections in renal allograft recipients (RAR) complicate treatment due to antimicrobial resistance and drug interactions.We present a case of NTM graft pyelonephritis,highlighting diagnostic and therapeutic hurdles,alongside the unwavering resilience of a medical aspirant who defied health challenges to chase her dream. Case Description: A 19 year old female with IgA nephropathy underwent an ABO-incompatible renal transplant.Six months later,she developed graft-site pain and swelling.Imaging confirmed graft pyelonephritis with a perinephric collection.Lab tests indicated graft dysfunction.Surgical drainage and broad-spectrum antibiotics were initiated,with MMF temporarily withheld while continuing tacrolimus and steroids.Acid-fast staining detected bacilli,but CBNAAT ruled out tuberculosis,suggesting NTM.Modified antimycobacterial therapy was initiated.Persistent wound discharge required multiple surgeries and antibiotic adjustments.Extended culture confirmed Mycobacterium chelonae,leading to targeted therapy.After 8 weeks,she made a remarkable recovery. This case epitomizes resilience—a driven medical aspirant,she overcame health setbacks,requalified for medical entrance,and now is in her third year of MBBS. Discussion: NTM diagnosis is intricate due to varied presentations and microbiological constraints.Management demands targeted antimicrobial therapy and surgical precision.This case exposes the complexities in RARs,where delayed recognition and mismanagement endanger graft survival. Beyond its clinical relevance,it exemplifies human resilience—unyielding strength in conquering health trials and defying adversity.Lab parametersFig a/b - Wound site/Resilience redefined