Here reports a rare case of severe pneumonia with pulmonary abscess and empyema caused by Trophe-ryma whipplei (TW) infection. TW infection was confirmed by clinical manifestations as well as polymerase chain reaction (PCR) of bronchoalveolar lavage fluid (BALF) and pleural effusion. After treatment with meropenem (fo-llowed by sequential ceftriaxone) combined with compound sulfamethoxazole, the patient improved and was discharged from hospital. Combined with literature review, this study explores the clinical manifestations, laboratory examinations, and treatment scheme of TW infection, aiming to improve the awareness and vigilance of clinicians on TW infection, conduct targeted anti-infection therapy as early as possible, and reduce the mortality of patients.