A 66 year-old woman was admitted to our hospital due to chills and fever on September 4, 2013. Two days prior to admission, she developed chills and fever (maximum temperature 39.5 °C) accompanied by pharynx pain, chest tightness, and headache. She had no cough, sputum, wheezing, dysphagia, hoarseness, weight loss, or edema of lower extremities. The patient was initially diagnosed with acute upper respiratory tract infection on admission. The patient had a history of type 2 diabetes mellitus for 4 years and denied a history of respiratory disease, trauma, or foreign-body ingestion. The patient was well built and nourished. Her temperature was 39.1 °C, pulse rate was 125 beats per min, respiratory rate was 24 breaths/min, and blood pressure was 110/68 mmHg. She had no clubbing, icterus, or generalized lymphadenopathy. Clinical examinations of the respiratory, cardiovascular, gastrointestinal, and nervous systems were normal. Routine laboratory examinations revealed a leukocyte count of 9900/μL with segmented neutrophils (88%), an elevated erythrocyte sedimentation rate (79 mm/h), and increased C-reactive protein (42.9 mg/dL, reference range ˂ 0.8 mg/dL). Computed tomography (CT) of the lung, magnetic resonance imaging (MRI) of the brain, and an ultrasonic study of the heart and liver were normal. On the 1st day, treatment with intravenous amoxicillin, levofloxacin, and ribavirin was initiated. On the 2nd day, the patient’s body temperature remained at 39.0 °C, and the preliminary result of blood culture was gram-positive cocci; therefore, the antibiotics were changed to teicoplanin and moxifloxacin. On the 5th day, the patient’s body temperature lowered, but dyspnea was suddenly worsened. The patient then went into respiratory and cardiac arrest, lost consciousness, and developed systemic cyanosis. Arterial blood gas analysis showed that arterial partial pressure of carbon dioxide was 52 mmHg, arterial partial pressure of oxygen was 57 mmHg, and pH was 7.35. The patient received cardiopulmonary resuscitation, intravenous epinephrine, and emergency tracheal intubation, and a simple breathing bag was used. She gradually regained consciousness and restored spontaneous rhythm. The patient was transferred to the Respiratory Intensive Care Unit. Penicillin-sensitive Kocuria kristinae was isolated from blood samples 5 d after the procedure (blood samples from both the left and right hand revealed the same bacterium); thus, a diagnosis of sepsis was made and intravenous antibiotic therapy was changed to vancomycin and piperacillin-tazobactam. In the afternoon of the 6th day, mechanical ventilation was withdrawn and the patient was extubated as the bedside chest radiograph showed no obvious abnormalities and evaluation of arterial blood gas analysis met the weaning criteria. On the 8th day, the patient developed dyspnea again. Her heart and respiratory rates slowed, she lost consciousness again and arterial blood gas analysis showed an arterial partial pressure of carbon dioxide of 82 mmHg, arterial partial pressure of oxygen of 259 mmHg, and pH value of 7.06. She gradually regained consciousness following emergency tracheal intubation and mechanical ventilation. Acute airway obstruction was considered as arterial blood gas analysis showed obvious acute retention of carbon dioxide before the second tracheal intubation. Her symptoms rapidly improved after the second intubation, respiratory secretions were less, and a radiological examination was normal; however, the cause of a possible airway obstruction was unclear. As central nervous system diseases could not be ruled out, a lumbar puncture was performed. Analysis of cerebrospinal fluid showed a high leukocyte count (350/μL, reference range 0-8/μL) with lymphocytes (75%), no Cryptococcus, and an increased protein level (132 mg/dL, reference range 8-43 mg/dL), which indicated the possible presence of intracranial infection, but cerebrospinal fluid culture was negative. On the 9th day, a CT scan of the neck demonstrated soft tissue swelling of the nasopharyngeal and oropharyngeal wall, and occlusion of the nasopharyngeal and oropharyngeal cavity. Bedside flexible bronchoscopy was performed that revealed edema of the nasopharynx and oropharynx mucosa. MRI was performed on the 13th day that showed obvious soft tissue swelling and thickening in the anterior region of the neck, with stenosis of the nasopharynx, oropharynx, and upper airway.