The antiphospholipid antibody syndrome (APS) is typically characterized by recurrent arterial and/or venous thromboses, miscarriages, and thrombocytopenia. There have been five reported cases of ARDS associated with primary APS. Adrenal insufficiency has also been reported as a rare complication of APS. We report a case of both ARDS and adrenal insufficiency associated with primary APS. Chest radiographs and pulmonary angiography studies revealed findings consistent with ARDS. CT scans confirmed the presence of bilateral adrenal hemorrhagic infarction. Patients with APS are at an increased risk of widespread vascular thrombosis due to the presence of circulating antiphospholipid antibodies. This case emphasizes the importance of recognizing APS and its potential for multiple organ system involvement.