# Concomitant Legionella pneumophila and Streptococcus pneumoniae Infections With Refractory Necrotizing Pneumonia in a Patient Receiving Immunosuppressive Therapy for COVID-19

## TL;DR

A rare case of severe pneumonia caused by two bacteria in a patient with COVID-19 who was on immune-suppressing drugs is reported.

## Contribution

Highlights a rare co-infection case in an immunosuppressed COVID-19 patient with Legionella pneumophila and Streptococcus pneumoniae.

## Key findings

- Co-infection with Legionella pneumophila and Streptococcus pneumoniae caused refractory necrotizing pneumonia.
- Immunosuppressive therapy for COVID-19 may increase susceptibility to bacterial co-infections.
- Early detection of bacterial infections is crucial in immunosuppressed elderly patients with COVID-19.

## Abstract

Bacterial co-infection in patients with coronavirus disease 2019 (COVID-19) is uncommon but represents a clinically significant complication. Such infections present both diagnostic and therapeutic challenges and are often associated with poor outcomes. We report a rare case of refractory necrotizing pneumonia caused by co-infection with Legionella pneumophila and Streptococcus pneumoniae in a patient with COVID-19 who was treated with dexamethasone and baricitinib. This case underscores the importance of maintaining a high index of suspicion for concomitant bacterial infections in immunosuppressed elderly patients with COVID-19 to ensure timely and appropriate intervention and thereby improve clinical outcomes.