Tropheryma whipplei is a Gram-positive bacterium that can cause chronic multi-system infectious diseases, but pulmonary involvement is rare. A patient with pulmonary abscess and pneumonia was admitted to our hospital. The clinical manifestations were cough and expectoration, and the lung CT showed cavernous lesions. Trophema whipplei was detected by metagene sequencing of bronchoalveolar lavage fluid. After treatment with ceftriaxone combined with sulfamethoxazole, the patient's condition improved fleetly. subsequently, sulfamethoxazole and clarithromycin were taken orally as maintenance therapy, the lung lesions were obviously absorbed during follow-up. This article reports the treatment process of this case.