A 46 year old man, with a personal history of smoking, ex parenteral drug abuse, hepatitis B and C infection, hepatic cirrhosis evolving for years and HIV infection diagnosed in 1988; currently receiving antiretroviral treatment. He was admitted to the ICU with acute inferoposterior myocardial infarction. Treatment was commenced with low molecular weight heparin and double anti-aggregation therapy with aspirin and clopidogrel. After 24 hours, he suddenly developed haemoptysis, acute hypoxemic respiratory failure and bilateral crackles, requiring orotracheal intubation and mechanical ventilation with FiO 2 of 1 to maintain a SpO 2 of 85-90%. The BAL return was increasingly bloody from both lungs. Due to the potential thrombogenic effect of systemic rFVIIa administration in acute myocardial infarction, and after informing and obtaining consent from the family, we decided on intrapulmonary administration of the drug at a dosage of 50 μg/Kg in 50 ml of isotonic saline via the bronchoscopy channel, observing the immediate cessation of bleeding. The FiO 2 was reduced to 0.5 over the first three hours and to 0.35 after 24 hours (figure 1). After 12 days on mechanical ventilation the patient was extubated and transferred to a stationary ward.