CASE PRESENTATION: A 68-year-old Caucasian female with a history of recurrent breast cancer and Sjögrens syndrome presented with worsening dyspnea. She was recently started back on her taxane chemotherapy. Following 4 weeks of treatment the patient developed dyspnea and was subsequently admitted to the hospital. CT of the chest demonstrated interstitial disease, with patchy ground glass opacities, possibly on an inflammatory basis. She discontinued her docetaxel and was treated with diuretics and IV steroids for concern of drug-related pneumonitis. She discharged following 2 days of treatment and improvement of her symptoms. Approximately 1 month later, she presented with worsening dyspnea. A CTA exhibited increasing interstitial changes noted within both upper lobes, as well as within the right middle lobe and within portions of the lower lobes compared to her previous CT. She also displayed prominent underlying chronic interstitial pulmonary fibrosis secondary to her Sjögrens. Bronchoscopy was non-diagnostic. Cultures were negative, however, she was still covered with broad spectrum antibiotics. Over the course of 6 days, the patient’s oxygen requirement increased and she was subsequently intubated due to her hypoxia. The patient developed severe ARDS and the patient’s family made her a DNR/DNI. The patient expired secondary to severe hypoxia.