A previously healthy 40-year-old woman was admitted with severe
dyspnea,
cough and slight
fever. Chest
X-ray film revealed bilateral widespread opaque infiltration with ground glass shadows around it. The laboratory examination showed moderate hepatic and muscular injury with
disseminated intravascular coagulation. In addition her arterial blood gas showed severe
hypoxemia (PaO2: 25 Torr under room air). Moreover, about 1 week prior to admission, 2 baby budgerigars she had been raising for half a year died. Because of this history and multi-organ
injuries, this disease was considered to be acute
pneumonia owing to fulminant
psittacosis causing acute
respiratory failure. On the first day of admission, she was intubated and ventilated mechanically with an
oxygen concentration (FIO2) of 100%. Subsequently, treatment with intravenous
minocycline (400 mg/day),
heparin for D.I.C. and
corticosteroid were started. Abnormal findings in both chest X-ray and several laboratory parameters improved gradually though
fever continued for a week. On the 14th day of her
hospital stay, she was weaned from the
ventilator successfully and the administration of
corticosteroid and
heparin tapered. On the 41st day, she was discharged without any symptoms. Results of
complement fixation (CF)
antibodies against chlamydia on paired sera showed a significant rise from 1:32 to 1:256. Moreover, both
IgG and
IgM antibodies for Chlamydia psittaci with microplate immunofluorescent antibody technique (MFA) showed an 8 times' rise during 10 days after admission. The definitive diagnosis was made with positive isolation of C. psittaci from both the throat swab of this patient and the spleen and liver of the dead budgerigar by the cell culture method.
Psittacosis should always be borne in mind as a possible cause of fulminant
pneumonia with acute
respiratory failure, and such a situation can be handled successfully if emergency care including
mechanical ventilation is available.