Basiliximab (Simulect), is a chimeric interleukin-2 receptor antibody (IL-2Rab), used as an induction immunosuppressive (IS) agent in renal transplant recipients (RTR), proven to be highly effective in preventing acute rejection (AR) episodes. It has an excellent safety profile and hypersensitivity reactions due to cytokine release syndrome following therapy have been rarely reported. We report a case of adult respiratory distress syndrome (ARDS) following Simulect administration. A 48-year-old lady with end stage renal failure and normal cardio respiratory status underwent renal transplantation with Basiliximab induction (2 doses on day 0 and day 4) followed by steroids, mycophenolate and tacrolimus as immunosuppression. There was immediate postoperative diuresis with excellent graft function and the patient received standard fluid management during and after surgery. She developed acute respiratory distress with clinical and radiological evidence of pulmonary edema on day 2 and day 4 post operatively, not responding to fluid restriction and diuresis. Cardiac and respiratory workup was normal and she was successfully treated with assisted ventilation and ultra filtration. Basiliximab induced cytokine release and increased capillary permeability leading to ARDS is a serious adverse event and improved awareness and prudent management can be life saving.