• Qian Yu, Xuchun Ding, Wen Wang, and Yafang Lou.
• Respiratory Department, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
• Medicine (Baltimore). 2021 Aug 6; 100 (31): e26842e26842.

IntroductionOpportunistic infection with multiple pathogens currently has become less uncommon since the application of immunosuppressant or corticosteroid in non- Human immunodeficiency virus patients. However, the clinical diagnosis of the co-infection remains difficult since the uncertainty and deficiency of the microbiologic testing methods.Patient ConcernsA 66-year-old male patient was admitted to our hospital with chest stuffiness, shortness of breath and elevated body temperature.DiagnosisHe was diagnosed with the co-infection of Pneumocystis jiroveci and cytomegalovirus by metagenomic next-generation sequencing of bronchoalveolar lavage fluid after bronchoscopy.InterventionsThe patient was empirically treated with broad-spectrum antibiotics, trimethoprim/ sulfamethoxazole and ganciclovir in the beginning of the admission.OutcomesThe condition of this patient was not improved even with the intervention at the early stage of the disease. His family requested discharge after 24 inpatient days.LessonsThis case highlights the application of metagenomic next-generation sequencing in the clinical diagnosis of pulmonary co-infection. Suitable prophylaxis, necessary clinical awareness and accurate diagnosis are indispensable for immunocompromised patients with pulmonary infection.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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