Gemcitabine is a newer pyrimidine analog used for the treatment of solid tumors. Though generally considered safe, it can cause pulmonary toxicity, which is generally mild and reversible. The purpose of this publication is to document a case of adult respiratory distress syndrome (ARDS) caused by Gemcitabine administration. The patient was noticed to have the extreme elevation of erythrocyte sedimentation rate (ESR) (> 100 mm/h) at the time of diagnosis. We observed excellent response to the corticosteroids. The ESR trended back to normal after the resolution of her symptoms thereby suggesting the utility of monitoring ESR in the diagnosis and management of Gemcitabine-induced pulmonary toxicity.