A 73-year-old man developed organized pneumonia with severe right-sided eosinophilic pleural effusion (PE). CD69+ and HLA-DR+ eosinophils in PE were 90 and 31%, respectively, but were undetectable in peripheral blood (PB). CD4+, CD45RA+ (naive) and CD4+, CD45RO+ (memory) cells in PB, PE and bronchoalveolar lavage (BAL) were 10.9, 8.4, 2.5 and 22.7, 38.3 and 16.4%, respectively. CD8+, CD45RA+ (naive) and CD8+, CD45RO+ (memory) cells in PB, PE and BAL were 3.5, 4.7, 1.0, and 8.9, 11.3 and 46.0%, respectively. The concentrations of interleukin-5 (IL-5) and IL-6 in PE were 1,680 and 2,797 pg/ml, respectively; however, these cytokines were undetectable in PB. The patient died 1 month after surgery to remove right thickened pleura. Microscopic findings showed right fibrinous pleuritis and organized pneumonia.