CASE PRESENTATION: A 31-year-old Hispanic male smoker with no significant past medical history presented with persistent bilateral hip and knee pain, fatigue, unintentional 30 pound weight loss, and a productive cough with scant hemoptysis. He had emigrated from Mexico 15 years prior and never returned. He worked in a chicken plant where he built coops and administered vaccinations to the animals. Laboratory data revealed a leukocytosis, normocytic anemia, hyperbilirubinemia, and thrombocytopenia. HIV testing was negative. Physical examination was unremarkable except for jaundice and submandibular lymphadenopathy. Chest x-ray revealed diffuse bilateral interstitial opacities. Computed tomography (CT) of the chest showed no pulmonary emboli, scattered areas of ill-defined ground glass opacities with interlobular septal thickening bilaterally, and hilar lymphadenopathy. He was started on broad-spectrum antibiotic therapy. Transthoracic echocardiogram revealed right heart failure. He was noted to have an increasing oxygen requirement and acutely decompensated requiring intubation for hypoxemic respiratory failure. Very rapidly thereafter, he suffered a cardiac arrest and was unable to be revived. Autopsy found the cause of death to be extensive tumor embolization within the pulmonary vascular circulation from a primary diffuse gastric adenocarcinoma.