Generative image compression has recently shown impressive perceptual quality, but often suffers from semantic deviations caused by generative hallucinations at ultra-low bitrate (bpp < 0.05), limiting its reliable deployment in bandwidth-constrained 6G semantic communication scenarios. In this work, we reassess the positioning and role of of multimodal guidance, and propose a Multimodal-Guided Task-Aware Generative Image Compression (MTGC) framework. Specifically, MTGC integrates three guidance modalities to enhance semantic consistency: a concise but robust text caption for global semantics, a highly compressed image (HCI) retaining low-level visual information, and Semantic Pseudo-Words (SPWs) for fine-grained task-relevant semantics. The SPWs are generated by our designed Task-Aware Semantic Compression Module (TASCM), which operates in a task-oriented manner to drive the multi-head self-attention mechanism to focus on and extract semantics relevant to the generation task while filtering out redundancy. Subsequently, to facilitate the synergistic guidance of these modalities, we design a Multimodal-Guided Diffusion Decoder (MGDD) employing a dual-path cooperative guidance mechanism that synergizes cross-attention and ControlNet additive residuals to precisely inject these three guidance into the diffusion process, and leverages the diffusion model's powerful generative priors to reconstruct the image. Extensive experiments demonstrate that MTGC consistently improves semantic consistency (e.g., DISTS drops by 10.59% on the DIV2K dataset) while also achieving remarkable gains in perceptual quality and pixel-level fidelity at ultra-low bitrate.