In May 3, 2025, a 59-year-old female patient was admitted to Shenzhen Traditional Chinese Medicine Hospital with complaints of fatigue and shortness of breath for over one month, worsened with cough and expectoration for 10 days. The case was engaged in agriculture for a long period of time, and worked in a restaurant 3 months prior to admission, with exposure to fresh food. Admission examinations showed a white blood cell count of 5.60 × 10⁹/L, a neutrophils proportion of 89.6%↑, an eosinophil count was 0.02 × 10⁹/L, and blood gas analysis revealed a pH value of 7.438, CO₂ partial pressure (PCO₂) of 35.5 mmHg, O₂ partial pressure (PO₂) of 57 mmHg↓, and oxygenation index of 173 mmHg↓. Pulmonary function tests revealed moderate to severe mixed ventilatory dysfunction with a positive bronchodilation test. Chest CT scans displayed diffuse mosaic and ground-glass opacities in bilateral lungs. Strongyloides stercoralis was found in sputum smears and bronchoalveolar lavage fluid under a bronchoscope. Targeted sequencing of bronchoalveolar lavage fluid under a bronchoscope identified 75 545 sequences of Pneumocystis jirovecii, and targeted sequencing of bloodstream infections identified 276 631 sequences of P. jirovecii, with abundance of 99.38%. The case was diagnosed as S. stercoralis and P. jirovecii co-infection in the lung, and was given oral administration of albendazole (0.4 g/d) and compound sulfamethoxazole tablets (0.4 g, 80 mg/6 h), along with anti-inflammatory and anti-asthmatic therapy. However, the patient’s disease condition continued to progress, with worsening dyspnea and remarkable chest tightness, and the case was promptly transferred to a specialized hospital for further management in May 9. Follow-up revealed that the infection continued to worsen after transfer to another hospital, endotracheal intubation, ventilator and ECMO support were given.