Objective To explore the etiologies, risk factors, clinical manifestations, and prognosis of pulmonary infection in patients with severe hepatitis. Methods The data on severe hepatitis with pulmonary infection in our hospital were retrospectively analyzed. Results 14 of 48 patients developed pulmonary infection; all of those had a history of antibiotic use and 4 had invasive procedures. The main clinical features were fever, cough and sputum, pulmonary rales, leukocytosis in the peripheral blood, and abnormalities on chest X-ray. The incidence of pulmonary infection in the late stage of severe hepatitis was up to 78.5%, and the efficacy was bad, with a mortality rate of 71.43%. Conclusions The incidence of pulmonary infection in patients with severe hepatitis is high, with various clinical manifestations and a greater mortality rate. Clinicians should be very careful with severe hepatitis with pulmonary infection. Comprehensive measures should be taken to prevent and treat pulmonary infection to reduce the related mortality rate.