Anaplasmosis could result in a lower respiratory tract disease but fulminant disease is rare and clinical improvement should have occurred with levofloxacin treatment [10] . Radiographic abnormalities also needed to be ruled out. Many critically ill patients have radiographic findings of viral pneumonitis, with bilateral interstitial and alveolar infiltrates. Multifocal and patchy abnormalities as seen in these patients have been reported in cases of 2009 H1N1 influenza A virus infection but do not completely rule out invasive bacterial infection [2] . Ground glass opacity and cavitary lobar opacity should focus attention on Legionnaire's disease [11] .