We describe 15 patients whose acute respiratory failure associated with pulmonary tuberculosis necessitated their ICU admission during a 42-month period. There was a 1.5% incidence of respiratory failure in hospitalized tuberculosis patients. Eleven of the 15 patients required ventilatory assistance for a mean 17.3 days. Five patients died in ICU (early mortality = 33%), and two others died within 3 months of discharge (total mortality = 47%). We began specific anti-tuberculous chemotherapy in these patients within 3 +/- 4 (SD) days after hospital admission. Pulmonary histology was available in five cases. Despite the clinical and radiologic features compatible with the adult respiratory distress syndrome in these patients, histology showed confluent tuberculous bronchopneumonia with no evidence of the syndrome.