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Volume 15
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10.3390/life15091336
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Case Report

Triple Pulmonary Coinfection with SARS-CoV-2, Nocardia cyriacigeorgica, and Aspergillus fumigatus Causing Necrotizing Pneumonia in an Immunomodulated Rheumatoid Arthritis Patient: Diagnostic and Therapeutic Insights

by
Wei-Hung Chang
1,
Ting-Yu Hu
1,2,* and
Li-Kuo Kuo
1
1
Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
2
Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan
*
Author to whom correspondence should be addressed.
Life 2025, 15(9), 1336; https://doi.org/10.3390/life15091336
Submission received: 25 July 2025 / Revised: 5 August 2025 / Accepted: 12 August 2025 / Published: 22 August 2025
(This article belongs to the Special Issue Advances in Intensive Care Medicine)
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Abstract

Pulmonary coinfection involving both viral and opportunistic pathogens is an emerging challenge in immunosuppressed patients. We report the case of a 59-year-old man with rheumatoid arthritis on long-term immunosuppressive therapy who developed necrotizing pneumonia and acute respiratory failure and was ultimately diagnosed with triple pulmonary coinfection by SARS-CoV-2, Nocardia cyriacigeorgica, and Aspergillus fumigatus. Diagnosis required comprehensive imaging, bronchoscopy with BAL, and microbiological work-up. The case was complicated by septic shock, multiple organ failure, and family-driven end-of-life decisions. This report highlights the diagnostic and therapeutic complexity of triple coinfection in the ICU, emphasizing the importance of systematic microbiology, imaging, and interdisciplinary care in critically ill immunocompromised hosts.
Keywords: triple infection; necrotizing pneumonia; SARS-CoV-2; COVID-19; Nocardia cyriacigeorgica; Aspergillus fumigatus; immunosuppression; rheumatoid arthritis; ICU triple infection; necrotizing pneumonia; SARS-CoV-2; COVID-19; Nocardia cyriacigeorgica; Aspergillus fumigatus; immunosuppression; rheumatoid arthritis; ICU

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MDPI and ACS Style

Chang, W.-H.; Hu, T.-Y.; Kuo, L.-K. Triple Pulmonary Coinfection with SARS-CoV-2, Nocardia cyriacigeorgica, and Aspergillus fumigatus Causing Necrotizing Pneumonia in an Immunomodulated Rheumatoid Arthritis Patient: Diagnostic and Therapeutic Insights. Life 2025, 15, 1336. https://doi.org/10.3390/life15091336

AMA Style

Chang W-H, Hu T-Y, Kuo L-K. Triple Pulmonary Coinfection with SARS-CoV-2, Nocardia cyriacigeorgica, and Aspergillus fumigatus Causing Necrotizing Pneumonia in an Immunomodulated Rheumatoid Arthritis Patient: Diagnostic and Therapeutic Insights. Life. 2025; 15(9):1336. https://doi.org/10.3390/life15091336

Chicago/Turabian Style

Chang, Wei-Hung, Ting-Yu Hu, and Li-Kuo Kuo. 2025. "Triple Pulmonary Coinfection with SARS-CoV-2, Nocardia cyriacigeorgica, and Aspergillus fumigatus Causing Necrotizing Pneumonia in an Immunomodulated Rheumatoid Arthritis Patient: Diagnostic and Therapeutic Insights" Life 15, no. 9: 1336. https://doi.org/10.3390/life15091336

APA Style

Chang, W.-H., Hu, T.-Y., & Kuo, L.-K. (2025). Triple Pulmonary Coinfection with SARS-CoV-2, Nocardia cyriacigeorgica, and Aspergillus fumigatus Causing Necrotizing Pneumonia in an Immunomodulated Rheumatoid Arthritis Patient: Diagnostic and Therapeutic Insights. Life, 15(9), 1336. https://doi.org/10.3390/life15091336

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