CASE PRESENTATION: A 30-year-old Chinese male was admitted with a 2-week history of fever and sputum. The peak temperature was about 38.5 ℃ and the sputum had a fishiness smell. He often had toothache. The physical examination was unremarkable. Initial laboratory findings were significant for WBC 11*10^9/L, with 68% neutrophils and CRP 107mg/L. Chest CT scanning showed a patch of infiltration with ground grass density and segmental distribution, two nodular opacities in the infiltration with 1-2 centimeter in diameter and a hole in one of the nodules. Firstly, he was treated with Amoxicillin/clavulanic for 1 week. The symptoms including fever disappeared and blood cell count came to normal. The follow-up CT showed that the infiltration with ground grass density disappeared, the nodule with a hole shrinked with the hole disappeared, but the other nodule seemed a bit larger. A computed tomography guided percutaneous needle biopsy was performed successfully. However, two hours later the operation, he complained of left chest pain and dyspnea. The breath sound of left lung was low. The chest X-ray showed no pneumothorax or obvious pleural effusion. Two days later, he began to have fever, with the peak temperature of 38 ℃ and dyspnea, while the chest pain was alleviated. The WBC was 12*10^9/L, with 79% neutrophils, CRP was 7.3mg/dl and procalcitionin (PCT) was 0.45ng/ml. The chest CT showed moderate pleural effusion in left thorax and bilateral infiltration. A pleurocentesis was performed and the pleural fluid analysis showed: WBC 1.2*10^9/L, neutrophil: 89%, total protein 59g/L, LDH 840U/L, ADA 21U/L. Imipenem/cilastatin and vancomycin were initiated and a pigtail catheter was placed for drainage. His symptom resolved in 3 days. The infiltration of the contralateral lung disappeared 1 week later, and the infiltration and pleural effusion was mostly absorbed in one month.