69-year-old, Chinese, male, with a history of ileus, was referred to the emergency department of our hospital because of worsening states in shortness of breath, cough and fever despite antibiotic therapy from another hospital. Upon admission, the patient had no other underlying diseases. 5 days before admission, he was diagnosed as upper respiratory tract infection in community clinic and accepted antibiotic therapy for 4 days. However, no improvement on his conditions were observed. On 11th in December 2014, his body temperature rose up to 39.5  C, then he presented to our hospital. After admission, a chest CT was performed which showed multiple dense consolidation located in right lung, predominantly in low lobe (Fig. 1A). His white blood cell (WBC) count was 6.30 x 10^9 cells/L, C-reactive protein was 6.8 mg/dL. Take all of these in consideration, we treated him with Piperacillin-sulbactam and levofloxacin. On 28th in December 2014, we performed bronchoalveolar lavage (BAL). Through bronchoscopy, we found that the wall of the air tube was edematous with a small amount of pus (Fig. 1B), the lavage was clear. Bronchoalveolar lavage fluid (BALF) cultures were negative for bacterial. Because there was only a small amount of pus in airways, bronchoscopic segmental lavage was not performed again. 2 weeks after treatment, a repeated chest CT showed the increased consolidation, while the patient's symptoms, including dyspnea, fever and pleuritic chest pain were improved. As a result, the patient was discharged on 28th in December 2014. Then he continued to receive antibiotic treatment for an additional week in clinic. However, the fever with highest temperature at 40.0  C occurred on 4th January 2015. He rehospitalized after 4 days, during which transbronchial lung biopsy (TBLB) was performed in the right lower lobe. Lung specimens showed chronic inflammatory cell infiltrated. Based on this, we empirically treated him with steroid. After steroid treatment, the patient was no longer feverish, other symptoms were also improved obviously. A chest CT performed after 1 week steroid treatment showed resolution of the radiographic abnormalities. In order to confirm the nature of the lesions, CT guided percutaneous transthoracic needle biopsy was performed. Lung biopsy showed lipid granulomas with fat-laden macrophages (Fig. 1D), consistent with the pathological features of lipoid pneumonia. After two months of missed diagnosis, the patient was diagnosed ELP at last. Oral systemic steroid was continued for 8 weeks with gradual tapering off. Chest CT showed dramatic improvement 1 year after steroid therapy. (Fig. 1C).