A 42-year-old male patient with history of alcohol abuse presented at a district hospital with fever and right chest pain. With diagnosis of severe pneumonia, he was treated with broad-spectrum antibiotics for seven days, but his clinical status was instable. Therefore, he was transferred to a tertiary hospital. Here several differential diagnoses were investigated aggressively and systemically. The results of bronchoalveolar lavage (BAL) fluid cultures showed the presence of mutiple pathogens, including Extended-spectrum-Beta-lactamase (ESBL) producing Klebsiella pneumoniae, multidrug-resistant (MDR) Pseudomonas aeruginosa, and Candida albicans. The apporpriate antibiotics and antifungal argent were initiated coupled with the adjunctive corticosteroid therapy. Although this regimen for the alcoholic patient with multiple-pathogen-induced pneumonia has never been reported, we were successful with patient recovered uneventfully. We concluded that a nonresponding pneumonia in alcoholic patient could be caused by multiple pathogens, especially in patients with a prolonged hospital stay and the corticosteroid should be considered using in similar cases.

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