Objective To highlight the characteristics of acute fibrinous and organizing pneumonia ( AFOP) . Methods The clinical, radiological and pathological data of two patients with AFOP were analyzed, and relevant literature was reviewed. Results Two male patients with the age of 48 years and 43 years presented with fever, cough, dyspnea and chest pain. The chest CT scan revealed multiple, bilateral, patchy consolidation distributing in peripheral areas in one case and consolidation in the middle lobe of the right lung and a little pleural effusion in another case. Two patients were diagnosed initially as community acquired pneumonia, but antibiotic treatment was ineffective. After the transbronchial lung biopsy and computed tomography guided percutaneous lung biopsy, pathological examination revealed there were numerous fibrin and organizing tissue in the alveoli without pulmonary hyaline membrane, which were consistent with AFOP. The patients showed significant clinical and radiological improvement after corticosteroid therapy. One patient was stable and the other one died of respiratory failure because of relapse during dose reduction of corticosteroids. Conclusions Patients of AFOP were misdiagnosed as pneumonia easily. Treatment with corticosteroids could be effective to some patients. If the antibiotic treatment was ineffective to the patient with fever and consolidation in the lungs, AFOP should be considered in the differential diagnosis.