Adult respiratory distress syndrome (ARDS) is rarely reported in association with typhoid fever despite the fact that sepsis is a common manifestation and endotoxemia has been described in this multisystem condition. We describe the course of a patient with ARDS and typhoid fever. With conventional treatment of the lung injury and with specific antimicrobial therapy, the patient survived. Recent consensus definitions of sepsis and ARDS simplified reporting of this case. Clinicians caring for individuals from or recent visitors to developing countries should be aware of the association of typhoid fever, sepsis, and ARDS.