Choriocarcinoma syndrome is a rare clinical entity with advanced, high volume choriocarcinomatous tumors and markedly elevated B-hCG (>50,000 IU/L). Recognition is important because the diagnosis of this syndrome identifies poor prognosis without mortality-proven management options. We present a case of a male in his twenties with metastatic choriocarcinoma who developed choriocarcinoma syndrome acutely after chemotherapy commencement. The patient deceased after hypoxic respiratory failure due to diffuse alveolar hemorrhage as a result of death of vascular tumors. While the prognosis for early diagnosis and treatment is excellent, the prognosis for late diagnosis is grim. Unfortunately, despite surgical or chemotherapeutic intervention, this syndrome has poor outcome.