Leptospirosis is a zoonotic disease associated with mild to severe pulmonary complications. On rare occasions, ARDS can be secondary to tropical disease. Accordingly, a history should include travel to endemic regions. Acute respiratory distress syndrome (ARDS), characterized by hypoxemic respiratory failure, is associated with a high mortality of and is precipitated by both direct and indirect pulmonary insults. Treatment is largely supportive, consisting of lung protective ventilation and occasionally requires Extra-corporeal membrane oxygenation (ECMO) and thereby necessitating Intensive Care Unit (ICU) admission. We describe a case of a 18-year-old male with undiagnosed leptospirosis, presenting with fever and severe hypoxemic respiratory failure, returning from a holiday. He was intubated and received lung protective ventilation followed by prone ventilation which failed. His condition improved after ECMO and antibiotic added empirically. This case illustrates the rare Complication of ARDS from leptospirosis, which may need ECMO and the importance of taking a travel history.

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