Tuberculosis (TB) remains a leading cause of mortality worldwide, with multidrug-resistant TB (MDR-TB) and immunocompromised patients at high risk. Pulmonary mycotic infections often mimic TB and may co-exist, leading to misdiagnosis and poor outcomes. We conducted a hospital-based cross-sectional study of 282 pulmonary cases. All patients underwent sputum analysis for Mycobacterium tuberculosis and evaluation for fungal co-infection. Data on HIV status and other immunocompromising conditions were recorded. We compared the prevalence of pulmonary fungal infections between MDR-TB and drug-susceptible TB cases, and between immunocompromised and immunocompetent patients. Fungal infections were detected in 128 patients (45.4%). The common isolates were Candida species (74 cases) and Aspergillus species (24 cases), followed by other opportunistic fungi. Pulmonary fungal co-infection prevalence was significantly higher in MDR-TB patients than in drug-susceptible TB patients (60.0% vs 42.6%, p = 0.03). Likewise, immunocompromised TB patients showed higher fungal co-infection rates than immunocompetent patients (70.4% vs 39.5%, p = 0.001). On multivariate analysis, MDR-TB and immunocompromised status were independently associated with increased odds of pulmonary mycotic infection. No significant association with sex was observed, but patients aged 21-40 and 61-80 had higher odds of fungal co-infection compared to those ≤20 years. In this cohort, pulmonary fungal infections were frequent among TB patients, especially those with MDR-TB or immunocompromised conditions. Our findings underscore the need for routine screening for fungal infections in TB patients with drug-resistant disease or immunosuppressive conditions may aid early detection and improve outcomes in this vulnerable population.