CASE PRESENTATION: A 38-year-old women, who had a fever for 7days, and dyspnea for 2days. Her past medical history was hypothyroidism. We had the diagnoses of respiratory failure of type I, severe pneumonia. Our immediate empiric antimicrobial therapy was ertapenem combined levofloxacin. On the third day of hospitalization, her dyspnea exacerbated with the temperature of 40℃, BP 77/47mmHg. She was transferred to the RICU and was given fluid resuscitation, vasopressors intubated and mechanically ventilated, but she remained persistently hypotensive, oxygen saturation could’t be messured.we completed ECMO by the bed, the shock was gradually corrected. We adjusted the antibiotics according to the sputum culture. and did some support treatments. Then cerebral hemorrhage and subarachnoid hemorrhage, bloodstream infection, puncture wound infection occured. She finally died in septic shock.