Abstract We report the case of a 34-year-old female who presented with acute respiratory failure and hemoptysis, requiring intubation and mechanical ventilation. Fiberoptic bronchoscopy revealed progressively bloodier returns during lavage, consistent with diffuse alveolar hemorrhage (DAH). This case highlights DAH as a rare but severe complication associated with cannabis use. DAH involves bleeding into the alveolar spaces, impairing gas exchange and causing respiratory distress. While cannabis use is not a well-established cause, this case underscores its potential to trigger serious respiratory complications. Recurrent DAH episodes can lead to long-term complications, such as interstitial fibrosis and emphysema, resulting in obstructive spirometry patterns. Acute complications, including...