Chlamydia psittaci infection can lead to severe clinical manifestations in humans, including rapidly progressive severe pneumonia, adult respiratory distress syndrome (ARDS), sepsis, multiple organ dysfunction, and even death. Here, we reported a 47-year-old man who presented with shortness of breath, fever and diarrhea. His chest CT showed right pneumonia with consolidation, and severe psittacosis pneumonia was confirmed by metagenomic sequencing of bronchoalveolar lavage fluid. The condition

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... ontinued to worsen under ventilator treatment, and ARDS occurred. VV-ECMO was used to support for five days to improve hypoxia. In the middle and late stage of the disease course, the ALT of the patient showed an upward trend, and the HBV DNA and hepatitis B surface antigen were positive. Considering the medical history, it might be acute hepatitis B, and antiviral therapy was given. After three weeks of combined therapy, the patient recovered and was discharged from the hospital. Chlamydia psittacosis pneumonia is prone to misdiagnosis and misdiagnosis when the symptoms are not typical, and high-throughput sequencing is needed for definite diagnosis. Short-term use of ECMO in severe pneumonia of Chlamydia psittaci can help shorten the course of the disease and reverse the disease. The route of viral hepatitis B infection is unknown. If acute hepatitis B co-infection with other pathogens initiates antiviral therapy, it may prevent its transformation to chronic.