DISCUSSION: Diffuse alveolar hemorrhage can be divided into immune and non-immune causes. The most common immune etiology is ANCA associated vasculitis. The typical presentation is hemoptysis, acute anemia, and evidence of diffuse pulmonary infiltrates on imaging. A retrospective study to assess factors to help prognosticate outcome of pulmonary hemorrhage found that mortality rates correlated with a high serum LDH, shock, renal failure, age > 60 years, cardiovascular diseases and need for chronic hemodialysis1. The presence of anti-proteinase-3 antibody is another poor prognostic factor 2. Our patient had poor prognosis due to her age, renal failure, and anti- Proteinase 3 antibodies. She died despite aggressive treatment with high dose steroids, cyclophosphamide and plasmapheresis. She was also treated with plasmapheresis, recommended for severe vasculitic disease in several studies including MEPEX trial3. Despite aggressive management she died.