This case report describes a 47-year-old male patient with insulin dependent diabetes mellitus (IDDM), Hepatitis B (HBV) infection, and diagnosed with co-infections of pulmonary tuberculosis (TB) and pulmonary candidiasis. The patient had history of discomfort in right side of chest, facial puffiness, and intermittent fever. X ray showed pneumothorax, necessitating the placement of an intercostal drainage (ICD) tube. A week prior, the patient exhibited a history of significant alcohol consumption. Diagnostic tests, including sputum analysis and bronchoalveolar lavage (BAL), confirmed an unusual dual infection by identifying the presence of Candida species and Acid-Fast Bacilli (AFB), indicative of tuberculosis. Co-infection among immunocompromised individuals with diabetes and chronic HBV is particularly rare. Pneumothorax and considerable lung damage resulted from the complex clinical history of concurrent tuberculosis and candidiasis. Granulomatous inflammation typically arises from pulmonary tuberculosis, while necrotising inflammation is associated with pulmonary candidiasis, an opportunistic infection. The patient's condition deteriorated due to the presence of these illnesses. This case highlights the challenges associated with identifying and treating co-infections in individuals with risk factors, including diabetes and chronic liver disease. Optimal outcomes are contingent upon timely detection and intervention. This case report outlines the complex interactions between fungal infections and tuberculosis, highlighting their implications for the prognosis, diagnosis, and treatment of immunocompromised individuals.