Acute myeloid leukemia with extramedullary pulmonary infiltration is a rare clinical case. Without specific clinical manifestations and imaging features, the diagnosis is often challenging, leading to a delay in treatment. The case is of a 66-year-old female patient, who visited the emergency department due to cough, fever and exertional dyspnea. Due to recurrent fever, a chest CT scan was performed and revealed lung abscess. Based on the initial diagnosis of lung abscess, pigtail catheter placement and bronchial biopsy were performed. The pathological report showed only chronic inflammation. Thus, the patient was treated with multiple antibiotics and antifungals. Due to the detection of blast cells in the peripheral blood via the complete blood count, bone marrow biopsy was performed and then acute myeloid leukemia was confirmed. However, the recurrent fever continued for one month. The medical team arranged thoracoscopy for right upper lobe resection, right lower lobe wedge resection, and lung pneumonolysis for the lung abscess. Pulmonary histopathological report eventually confirmed acute myeloid leukemia with extramedullary pulmonary infiltration. This case suggested that when a patient has recurrent fever and the CT image shows suspected lung abscess formation, antibiotic treatment may not be effective. Extramedullary infiltration of leukemia should be suspected in the differential diagnosis. Once confirmed as extramedullary pulmonary infiltration of leukemia, leukemia related treatment should be provided as soon as possible. The delay of cancer treatment, which may increase the risk of mortality.