Pseudomonas aeruginosa pneumonia is a rare community-acquired pneumonia, which usually occurs in immunocompromised and chronically ill patients, and rarely in healthy ones. The early symptoms are fever, purulent sputum, and hemoptysis, making it difficult to distinguish from common pneumonia. However, this type of pneumonia leads to rapid progression to respiratory failure. Here we report a 62-year-old healthy male plumber without chronic diseases who had back pain, chest pain, and a cough with blood-tinged sputum for several days. On admission, a chest X-ray showed right upper lobe pneumonia. Initially he was treated with empirical antibiotics. Massive hemoptysis and respiratory failure developed the day after admission. Computerized tomography revealed necrotizing change of the right upper lobe lung and consolidation of the posterior parts of both lungs. He underwent thoracoscopic right upper lobectomy because of the disease progression, and was discharged uneventfully. Based on the disease presentation of our patient, we consider his condition to be compatible with the diagnosis of Pseudomonas aeruginosa necrotizing pneumonia. Early surgical intervention combined with adequate antibiotics could have saved the patient’s life.