Scopulariopsis Pleural Empyema Coinfection With Pneumocystis Jirovecii Pneumonia and Cytomegaloviraemia in an Immunocompromised Patient: A Case Report and Review of the Literature

_Microascus gracilis_ is a rare cause of empyema. A 70s year old male present with worsening dyspnoea who was found to have spontaneous pneumothorax and thoracic empyema of the right lung coinfection with _Pneumocystis jirovecii_ pneumonia and cytomegaloviraemia. _M. gracilis_ identified from pleural fluids and the removed chest tube had high minimum inhibitory concentration values of currently available antifungal agents. The patient was treated with an antifungal regimen of caspofungin combined with posaconazole and then with terbinafine plus posaconazole for sequential therapy. Thymosin α1 plus immunoglobulin was also administered as adjuvant immunomodulatory therapy. This case highlights the importance of an accurate diagnosis, along with appropriate antifungal therapy in combination with immunomodulatory therapy to achieve complete recovery after _M. gracilis _infection.