Non-Hodgkin lymphoma was diagnosed in October 1999, and was treated with six cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) and intrathecal methotrexate for CNS prophylaxis. The disease recurred 6 months after chemotherapy, and the patient was retreated with three cycles of rituximab and ICE (ifosfamide, carboplatin, and etoposide). He then underwent allogeneic T-cell–depleted HSCT from his human leukocyte antigen-identical sister in January 2001 after a conditioning regimen of cyclophosphamide, thiotepa, and hyperfractionated total body irradiation. His posttransplant course was complicated by relapse of the underlying disease, graft-vs-host disease of the skin and GI tract, hypothyroidism, autoimmune idiopathic thrombocytopenic purpura, penicillin-resistant Streptococcus pneumoniae, and atrial fibrillation treated with rate control and warfarin. One month prior to the current ICU admission, he was also admitted to the ICU with mild hemoptysis, dyspnea, and pulmonary edema. Echocardiography at that time revealed moderate mitral regurgitation and overall preserved left ventricular function. The warfarin was discontinued, and he was treated with IV antibiotics and diuretics with resolution of pulmonary symptoms. He remained on corticosteroids and sirolimus for treatment of the graft-vs-host disease. He went home and returned to the hospital 12 days later with recurrence of hemoptysis.