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A 71-year-old male a chronic smoker, who also had diabetes mellitus and hypertension presented with complaints of fever, cough with foul-smelling sputum and dyspnoea for 25 days. Coarse crepitations were evident in the interscapular area, infrascapular, axillary, infra-axillary and mammary areas on the left side. Contrast-enhanced computed tomography of the chest showed necrotic mediastinal lymph nodes and areas of consolidation in the left upper lobe. Bronchoalveolar lavage fluid polymerase chain reaction identified Staphylococcus, New Delhi metallo-β-lactamase (NDM) producing Klebsiella; GeneXpert detected Mycobacterium tuberculosis complex. Pleural fluid analysis was suggestive of exudative effusion with elevated adenosine deaminase. The patient was managed with anti-tuberculosis treatment, ceftazidime-avibactam, aztreonam and linezolid.