CASE PRESENTATION: A 59-year-old man with a history of cocaine, alcohol, and K2 abuse was admitted to the medical ICU after a generalized tonic-clonic seizure. The patient admitted to using K2 three times in the days prior. Initial vital signs were notable for a pulse oximetry (SpO2) reading of 86%. High-flow nasal cannula (HFNC) was applied and SpO2 improved to 94%. A chest X-ray showed diffuse, bilateral parenchymal opacities. Shortly after admission to the MICU the patient had a witnessed episode of small-volume hemoptysis. Collateral information obtained from another hospital revealed that the patient had a seizure two months earlier in the setting of K2 intoxication, hemoptysis with diffuse airspace opacities on chest imaging, and cardiac arrest requiring endotracheal intubation. On the current presentation, the patient’s hypoxia stabilized with the use of HFNC. No further episodes of hemoptysis occurred so bronchoscopy was deferred. Given the clinical and radiographic findings, we gave the patient methylprednisolone for presumed drug-induced DAH. By hospital day two, the patient was weaned from HFNC to low-flow nasal cannula. Serologic work-up revealed no evidence of autoimmune disease or vasculitis. Three months later, the patient was abstaining from K2 and a chest X-ray showed resolution of the diffuse airspace disease.