Pulmonary involvement is well documented in European Puumala hantavirus infection. From a single outbreak in our county, we report on three cases of life-threatening hantavirus pulmonary syndrome. Arguably, additional cases are likely to either go undiagnosed or unreported. A clinical implication of this observation is that hantavirus infection should be included as a differential diagnosis for patients with febrile illness and acute respiratory distress of uncertain cause in endemic areas in Eurasia.