A 82-year-old male patient was hospitalized in the Respiratory Department for "repeated cough and shortness of breath for 10 years, recurrence worsened for 1 month". Later, he was transferred for further diagnosis and treatment, to the Infectious Disease Department for further hospitalization. Previously, the patient had repeatedly undergone tuberculosis-related examinations and showed further improvement in the bronchoscopy examinations. However, no evidence of Mycobacterium tuberculosis infection was found. Early anti-infection treatments failed. Due to repeated symptoms, we performed bronchoscopy again and sent alveolar lavage fluid for next-generation sequencing (NGS) test. Subsequently, Mycobacterium tuberculosis and Candida albicans were detected by NGS. After anti-tuberculosis and anti-fungal treatments, the symptoms were significantly relieved, and the chest CT showed absorption of the lung lesions. Therefore, we successfully diagnosed and treated a case of recurrent pneumonia with tuberculosis and candida co-infection diagnosed by NGS.