CASE PRESENTATION: A 62 year old female with a history of colon cancer on FOLFOX (folinic acid, 5-fluorouracil, and oxaliplatin) presented with cough and shortness of breath on Dec. 25th, 2015. She was noted to have 3 admissions for pneumonia between Oct. 2015 and Dec. 2015. She was treated with antibiotics but never had complete recovery and eventually became O2-dependent. She continued FOLFOX and began cycle 10 on Dec. 2nd,2015. She was admitted a 4th time on Dec. 25th, 2015. She had persistent cough, purulent sputum, and was hypoxemic. CT chest revealed progression of bilateral interstitial opacities and new diffuse groundglass opacities as compared to CT chest Dec. 7th. She underwent VATS with right lower lobe biopsy on day 5. Pathology revealed interstitial thickening and active fibroblastic proliferation with type-2 pneumocyte hyperplasia and intra-alveolar fibrin deposition. Findings were consistent with diffuse alveolar damage. All cultures were negative. Anti-nuclear antibody, rheumatoid factor, anti-citrullinated protein, anti-Ro/La, anti-RNP, and p- and c-ANCA were negative. Given the temporal relationship to oxaliplatin, a diagnosis of DILD was made. She was treated with high-dose steroids. Two months after discharge, she was no longer on oxygen and was subjectively improved.