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We examined clinical features and outcomes of mechanically ventilated patient (n = 11) retrospectively who had developed acute respiratory failure during treatments with immunosuppressive drugs. The mean APACHE II score was 22.6, and the mean lung injury score was 2.9. In eight patients chest X-ray and computed tomography showed interstitial pneumonia. Fungus and/or cytomegalovirus were isolated most often from patients with interstitial pneumonia. Observed mortality (72.7%) was significantly (P < 0.001) higher than predicted mortality (45.1%) in the APACHE II score. Patients, who were complicated with septic shock caused by fungus infection, showed poor mortality. These results suggest that the fungus and cytomegalovirus infections might be associated with poor prognosis in patients with acute respiratory failure during treatment with immunosuppressive drugs.

A 64-year-old male was admitted to our hospital with dyspnea and high fever. The patient had a relative bradycardia and severe hypoxemia. Velcr rales were heard throughout the entire lung fields. Leucocytosis was absent. Chest X-ray showed bilateral diffuse reticular shadows. Corticosteroid pulse therapy and minocycline were introduced on the suspicion of either idiopathic interstitial pneumonia or Chlamydial pneumonia. Subsequently, his symptoms gradually improved. Although the patient had no history of exposure to birds, the titer of complement fixation test for Chlamydia was 1:32 during the acute illness. Microplate immunofluorescence antibody technique proved infection with Chlamydia pneumoniae. We consider this is a rare case of severe pneumonia caused by C. pneumoniae.