Severe respiratory failure is an uncommon manifestation of psittacosis. We describe a patient with psittacosis who developed severe respiratory failure and required artificial ventilation. We also review 11 cases reported in the English-language literature over the past 30 years. A history of exposure to birds was reported in 10 of 12 cases and remains the most significant risk factor. Severe hypoxemia or renal impairment was associated with a poor prognosis. Eight patients died of psittacosis or related complications of the infection. Diagnostic aspects, clinical manifestations, and management options are discussed.