De Bels et al. Journal of Medical Case Reports 2012, 6:20 http://www.jmedicalcasereports.com/content/6/1/20 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Successful treatment of Chlamydophila pneumoniae acute respiratory distress syndrome with extracorporeal membrane oxygenator: a case report and diagnostic review David De Bels1*, Philippe Gottignies1, Marijke Reynders2, Sébastien Roques1, Stephan Wilmin1, Véronique-Yvette Miendje Deyi3, Sophie Jamart1 and Jacques Devriendt1 Abstract Introduction: Chlamydophila pneumoniae is a respiratory pathogen known to infect the upper and lower respiratory tracts. Infection severity can range from sub-clinical pulmonary infection to acute respiratory distress syndrome. Case presentation: A previously healthy 62-year-old Caucasian man was admitted to our hospital for acute respiratory failure. Serum samples obtained every week starting from the day of admission showed clear-cut seroconversion for C. pneumoniae antibodies. All other cultures obtained during the first days of hospitalization were negative. Despite maximal ventilatory support (high positive end expiratory pressure, fraction of inspired oxygen of 1.0, nitric oxide inhalation, neuromuscular blocking agents and prone positioning), our patient remained severely hypoxemic, which led us to initiate an extracorporeal membrane oxygenation treatment. Extracorporeal membrane oxygenation and hemodiafiltration were withdrawn on day 12. Our patient was extubated on day 18 and discharged from our Intensive Care Unit on day 20. He went home a month later. Conclusion: We describe the first published case of acute respiratory distress syndrome due to C. pneumoniae infection successfully treated by extracorporeal membrane oxygenation, a very useful tool in this syndrome. A quick and specific method for the definite diagnosis of Chlamydophila infection should be developed. Introduction Chlamydophila pneumoniae is an obligate intracellular Gram-negative bacterium. The spectrum of disease, in addition to pneumonia and influenza-like illness, includes pharyngitis, sinusitis, bronchitis, exacerbation of chronic obstructive pulmonary diseases and reactive arthritis [1-5]. C. pneumoniae accounts for 6% to 20% of cases of community-acquired pneumonia (CAP) [1,2]. Many of these cases have few symptoms and don’t require hospitalization (’walking pneumonia’). However, more severe cases may occur, with up to 18% requiring hospitalization [6] and even mechanical ventilation, especially in elderly, immunocompromised hosts and * Correspondence: david.debels@chu-brugmann.be 1Intensive Care Department, Brugmann University Hospital, 4 Place Van Gehuchten, 1020, Brussels, Belgium Full list of author information is available at the end of the article patients with coexisting cardiopulmonary disease [7], but also, rarely, in previously healthy adults [8]. Old and new macrolides are effective against C. pneu- moniae and have been recommended as first-line treat- ment. New fluoroquinolones are also effective in vitro against C. pneumoniae and can be used. Studies have shown that 35% to 47% of C. pneumoniae pneumonia is mixed with other pathogens, the most common being Streptococcus pneumoniae [9,10]. We describe the case of severe CAP due to C. pneu- moniae infection in a previously healthy adult patient, with acute respiratory distress syndrome (ARDS) neces- sitating extracorporeal membrane oxygenation (ECMO). Case presentation A previously healthy 62-year-old Caucasian man was admitted to our hospital for acute respiratory failure. © 2012 De Bels et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.