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Pneumocystis jirovecii pneumonia (PJP) is an increasingly recognised opportunistic infection among non-HIV immunocompromised patients receiving prolonged corticosteroid and immunosuppressive therapy who may present with progressive dyspnoea and fever and are initially treated for community-acquired pneumonia. Rapid clinical deterioration led to respiratory failure requiring invasive mechanical ventilation. Imaging revealed diffuse ground-glass opacities with bilateral pneumothoraces. Microbiological testing of sputum confirmed PJP. Despite targeted antimicrobial therapy and pleural drainage, the clinical course was complicated by persistent air leak, ventilator-associated pneumonia and refractory hypoxaemia, resulting in death. This case highlights the importance of early suspicion for PJP in non-HIV immunosuppressed patients and underscores bilateral pneumothorax as a rare but life-threatening complication. Consideration of prophylaxis and prompt evaluation for structural complications are essential to improve outcomes in high-risk populations.