Transfusion related acute lung injury (TRALI) is a life threatening and potentially fatal complication of blood component transfusion, which largely remains under- diagnosed and under-reported, especially in neonates. The present case aims to emphasize that TRALI should be kept as a differential diagnosis in all groups of patients, including neonates, who develop acute respiratory distress and fresh lung infiltrations in the chest radiograph within 6 h of blood component transfusion in the absence of evidence of volume overload or cardiac dysfunction. Its recognition is important in view of the associated illness and death, for instituting correct management, and for eliminating implicated donors from donor panels.