We provided care for a 37-year-old African-American man who had experienced recent infection with hepatitis B. He presented with mononeuritis multiplex, significant weight loss, and fever. A sural nerve biopsy showed necrotizing vasculitis involving medium- sized arteries. He was diagnosed with PAN and was treated with high-dose corticosteroids, lamivudine and plasmapheresis. In the course of treatment, the patient developed respiratory distress requiring mechanical ventilation. Chest radiographs showed bilateral patchy alveolar infiltrates, and his hemoglobin and hematocrit levels had dropped from 13.9 g/dL and 43% to 11 g/dL and 32%, respectively. There was no evidence of hemolysis or GI bleeding. Over the next few days, there was progression of alveolar infiltrates associated with a further drop in hemoglobin and hematocrit levels to 6.5 g/dL and 19%, respectively, which is suggestive of alveolar hemorrhage. After about 3 weeks of continued treatment with corticosteroids and plasmapheresis, the patient’s condition clinically improved, with clearing of the infiltrates on the chest radiographs.