A 78-year-old patient was admitted to Haikou People’s Hospital in June 2021 due to “recurrent cough, expectoration and shortness of breath for 9 days and aggravation for 1 day”. The patient is a farmer with a history of frequent soil contact. Wet rales can be heard in both lungsat admission examination. The C-reactive protein was 97.61 mg/L. Sputum culture and blood culture were negative. Chest CT showed multiple mass radiography and exudation in both lungs and a small effusion in the right pleural cavity. A small amount of active bleeding was observed in the upper lobes of both lungs, with a few visible blood clots during bedside tracheoscopy. The patient was initially treated with antibiotics in accordance with the “lung infection” treatment, which did not respond well. Alveolar lavage fluid examination revealed Strongyloides faecalis. Metagenomic sequencing revealed 587 genes of Legionella pneumophila and 155 genes of S. faecalis. Pulmonary strongyliasis and L. pneumophila infection were diagnosed. The patient was treated with albendazole tablets (0.4 g, quaque die, 7 d; 0.4 g, bis in die, 21 d), azithromycin tablets (100 mg, quaque die, 14 d) and levamisole tablets (0.5 g, quaque die, 12 d). The patient’s condition improved 45 days after the treatment. The chest CT showed pulmonary inflammatory lesions absorption improved significantly. One month later, no recurrence was found in the reexamination.