Forage legumes face simultaneous abiotic and biotic stresses, causing substantial yield losses. This study explores the combined impacts of drought and Phoma medicaginis infection on the growth and photosynthetic activity of Medicago truncatula contrasting lines TN6.18 and F83005.5. The tolerant TN6.18 line exhibits superior tolerance to combined drought and P. medicaginis infection, manifesting in minimal leaf area reduction, the highest number of healthy leaves, increased carotenoids content, a consistently high and stable photosynthesis rate, and enhanced performance of photosystems PSI and PSII. On the contrary, the sensitive F83005.5 line shows pronounced leaf chlorosis, particularly under drought stress, and decreased pigment levels under the combination of drought and P. medicaginis infection stresses (combined stress). Moreover, the drought-stressed F83005.5, experiences reduced hydration and photosynthetic performance, linked to diminished gas exchange and chlorophyll fluorescence parameters. Chlorophyll fluorescence revealed more severe PSI impairment than PSII under combined stress. In conclusion, understanding the Pm8 infection-drought interaction enhances insights into M. truncatula resistance mechanisms to the combination of these stresses.