A 30-year-old male farmer with no tobacco or drug use and no significant past medical history was transferred from a local hospital to the intensive care unit of a university hospital due to hypoxia and worsening dyspnoea over the course of two days after working in a corn storage unit. Upon arrival at the local emergency department, a non-rebreather mask was required to raise the patient’s oxygen saturation. Chest X-ray demonstrated bilateral ill-defined small opacities (figure 1). Computed tomography scan of the thorax showed diffuse ground glass central-lobular nodules (figure 2). The complete blood count revealed a white cell count of 23,100/mm3 with 95% neutrophils and 2% lymphocytes. Overnight, the patient’s respiratory condition deteriorated and warranted mechanical ventilation with high-dose steroids.