Dual Mycobacterial Infection: Rare Coinfection of Mycobacterium tuberculosis and Nontuberculous Mycobacteria

There is little research on the subject, despite the rising prevalence of concurrent <i>Mycobacterium tuberculosis</i> (MTB) and nontuberculous mycobacteria (NTM) infections. We present the case of a 48-year-old immunocompetent man diagnosed with pulmonary tuberculosis with simultaneous sputum cultures positive for NTM. Chest imaging revealed bilateral upper-lobe cavitary lesions, and serial sputum studies demonstrated persistent MTB on acid-fast bacilli smears and MTB polymerase chain reaction. Standard four-drug antituberculous therapy was initiated. However, concurrent sputum cultures subsequently grew <i>Mycobacterium abscessus</i> and later <i>Mycobacterium avium</i> complex, prompting the addition of amikacin, cefoxitin, and azithromycin based on infectious disease consultation. This case illustrates the diagnostic and therapeutic challenges inherent to MTB-NTM coinfection, where distinguishing true NTM disease from colonization is critical, and underscores the importance of multidisciplinary management.