Background: Mycobacterium avium complex (MAC) infections are increasingly recognized as significant opportunistic pathogens, particularly in immunocompromised hosts. With advances in diagnostic methods, including RNA probes and fluorescent stains, accurate identification of MAC is feasible, although challenges persist in detection. Case Report: We present the case of a 62-year-old female with a BMI of 15 kg/m² and a history of tuberculosis, Barrett's esophagus, adrenal adenoma, chronic obstructive pulmonary disease, primary hyperparathyroidism, and alcohol abuse, who presented with difficulty walking upon waking and altered mental status. Radiological findings suggested MAC involvement, confirmed by biopsy, despite negative acid-fast bacilli staining. Additionally, the patient exhibited Enterobacter urinary tract infection (UTI), complicating the diagnostic and therapeutic approach. Treatment included a combination of antibiotics targeting both UTI and suspected MAC infection. Conclusion: This case emphasizes the challenges in diagnosing and managing MAC infections in immunocompromised patients. Tailored antimicrobial therapy, multidisciplinary collaboration, and consideration of surgical intervention are crucial for optimizing outcomes in such cases.