A 38 year-old female with no significant medical history was transferred to a medical centre in Hawaii after near-drowning at the beach. She was noted to have increasing shortness of breath. Subsequently she was placed on non-invasive ventilation and then intubated for respiratory support. She was thought to have early stage acute respiratory distress syndrome after sea water aspiration. By multidisciplinary treatment, she was able to be extubated successfully on hospital day 5, and then flew back to Japan. When visiting our hospital in Japan, further examinations were conducted for prolonged respiratory symptoms and pulmonary infiltrates by CT. A specimen obtained by transbronchial lung biopsy revealed organising pneumonia which was thought to be related to sea water aspiration. Methylprednisolone treatment resolved her respiratory symptoms and pulmonary infiltrates.