Background : Atypical mycobacterium infect ion occurs under certain skin conditions, namely the disruption of skin integrity and mucous membranes accompanied by the reduction of cellular immunity. However, a typical mycobacterial infection in elderly patients is rarely reported. Case : A 64 years old male patient , complained of red lumps on the upper-back for a mont h , accompanied by mild fever and minimal pain. Three months before, the patient had ac c upuncture on the neck and upper back. Physical examination showed multiple miliar to lenticular sized papules and pustules on an erythematous-violaceus base with hard and immobile palpable nodes and infiltrate. After clinical and laboratory workup, the patient was diagnosed with carbuncle with C andida spp colonization. T he t reatment consist ed of s y stemi c antibiotic s and topical antifungal s . There w as no clinical improvement after 3 weeks. Histopathology and laboratory result s su g gested atypical mycobacterium infection. Discussion : Atypical mycobacterium infection should be considered in elderly patients with skin and soft tissue infections that show no clinical improvement tostandard therapy . Keywords : s kin and soft tissue infection, atypical mycobacterium, geriatric patients