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

There is little research on the subject, despite the rising prevalence of concurrent Mycobacterium tuberculosis (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 Mycobacterium abscessus and later Mycobacterium avium 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.