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

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.