Bird flu or avian flu, caused by H5N1 virus, is a new emerging infectious disease. There has been worldwide avian influenza infections in poultry since 1997. Recently, H5N1 caused severe disease with high mortality in humans in Vietnam and Thailand.¹ Most infected cases usually developed progressive pneumonia with acute respiratory distress syndrome and consequently died. Atypical presentations of patients with bird flu were also noted. de Jong et al recently reported a fatal bird …