# Three in One: A Case Report of Pulmonary Co-infection With a Virus, a Bacterium, and a Fungus in an Immunocompetent Adult

## TL;DR

This paper reports a rare case of triple lung infection in a healthy elderly man, involving a virus, a fungus, and a bacterium.

## Contribution

The novelty lies in documenting a triple co-infection in an immunocompetent adult without chronic lung disease.

## Key findings

- An elderly male was diagnosed with co-infection of coronavirus NL63, Coccidioides, and Mycoplasma pneumoniae.
- The case highlights the possibility of complex co-infections in patients without known immunodeficiencies.
- The clinical course offers insights for diagnosing and managing rare pulmonary co-infections.

## Abstract

Pneumonia is a common cause of morbidity and mortality in the United States and worldwide. It is most commonly caused by a single organism, but co-infection can occur. Nevertheless, there are no or very few reported cases of triple acute co-infection with a virus, a bacterium, and a fungus in an immunocompetent patient without underlying chronic lung disease. Here, we discuss a case in which an otherwise healthy, elderly male exhibited a triple co-infection with coronavirus NL63, Coccidioides immitis or Coccidioides posadasii (also known as a cause of Valley fever), and Mycoplasma pneumoniae. We discuss the insight this clinical course can provide on future diagnosis and management of pulmonary coinfections.