We report a case of acute respiratory distress syndrome caused by uropathogenic Escherichia coli induced sepsis and treated successfully. A 56-year-old women admitted for high-fever, dyspnea, and disturbance of consciousness on September 11, 2006, was found in chest computed tomography (CT) on admission to have diffuse infiltration with bilateral pleural effusion. Abdominal CT on admission showed left hydronephrosis complicated with ureteral stones. Because of severe hypoxemia, mechanical ventilation was started from hospital day 1. She went into shock soon after admission. Under mechanical ventilation, she was administered several antibiotics and dopamine. Because sera endotoxins were elevated, she was treated by endotoxin adsorption therapy on hospital day 3. A urethral stent was indwelled in the ureter for drainage after endotoxin adsorption therapy. Because Escherichia coli was isolated from urine and blood cultures, she was diagnosed with acute respiratory distress syndrome (ARDS) caused by E. coli inducing septic shock. After therapy, her condition improved, and she was extubated on hospital day 9. Extracorporeal shock wave lithotripsy was conducted on hospital day 19 and she was discharged.