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Primary pulmonary intravascular large B-cell lymphoma (IVLBCL) is a rare malignant extranodal lymphoma, and it presents symptoms similar to those of lung diseases. Diagnosis of IVLBCL can be challenging and often requires histopathological examination of affected tissues. The present report describes a 65-year-old female patient presenting with a fever, without generalized lymph node enlargement. A CT scan revealed subpleural ground-glass opacities in the upper lobe of the right lung. The lactate dehydrogenase, erythrocyte sedimentation rate and CRP levels were all elevated. The patient had been misdiagnosed with pneumonia by multiple hospitals, and treatments with anti-infective and anti-inflammatory therapies proved ineffective. Subsequently, the patient underwent a CT-guided puncture biopsy of the lesion in the upper lobe of the right lung at the Second Hospital of Dalian Medical University (Dalian, China). Based on the cell morphology, combined with clinical manifestations and other laboratory tests, the possibility of lymphoma was considered. The diagnosis was subsequently confirmed by histopathological examination. To the best of our knowledge, this is the first description of the features of IVLBCL cells under a microscope using an oil-immersion objective lens. [ABSTRACT FROM AUTHOR]