Acute respiratory distress syndrome (ARDS) associated with Mycoplasma pneumoniae infection is unusual. We herein report a previously healthy young man who developed ARDS after 7 days of respiratory symptoms. M. pneumoniae infection was diagnosed by a positive test for M. pneumoniae IgM and a positive cold agglutinin test. The patient recovered eventually after receiving effective antibiotic treatment and mechanical ventilation for 8 days. Six additional cases of M. pneumoniae infection with ARDS were reviewed. M. pneumoniae should be considered as an etiological agent in a delayed onset of ARDS after pneumonia.