Objective To investigate the clinical features, imaging features, diagnosis and treatment of severe Chlamydia psittaci pneumonia in order to facilitate early diagnosis and treatment and reduce the mortality rate. Methods The clinical data of 7 patients with severe Chlamydia psittaci pneumonia diagnosed in Fujian Provincial Hospital from October 2019 to July 2020 were retrospectively analyzed. Results Among the 7 cases, there were 5 males and 2 females, aged 59 to 69 years. The main clinical manifestations were fever, cough, sputum, dyspnea, and some symptoms of digestive and nervous systems. The total number of white blood cells was normal or slightly higher in 7 patients, the absolute value of lymphocytes was decreased, C-reactive protein was significantly increased, and respiratory failure occurred in all 7 patients. Chest CT showed large patchy consolidation shadows accompanied by air bronchogram signs, which progressed in a short period, followed by a small amount of pleural effusion. The specific DNA fragments of Chlamydia psittaci were identified by metagenomic next-generation sequencing in all 7 patients. Six patients were treated with doxycycline, 1 with azithromycin, and 7 relieved with improved symptoms and imaging. Conclusions For elderly patients with acute onset, high fever with cough, difficulty breathing, especially with a history of poultry or birds, whose chest images suggest large consolidation effusion shadows, empirical antibiotic for community-acquired pneumonia is invalid, psittacosis chlamydia pneumonia should be highly suspected. Therefore second-generation sequencing of respiratory secretions is necessary so as to determine the pathogens. Tetracycline class antibiotic treatment should be given as soon as possible after the diagnosis of psittacosis chlamydia pneumonia.