DISCUSSION: DAH is a very rare phenomenon in the presence of Cryoglobulinemia with unclear prevalence. Hospital based studies have identified an incidence of 2-3 % (1,2). Disease activity usually corresponds to HCV RNA levels and virologic remission has been shown to cause cryoglobulinemia quiescence. DAH despite RNA clearance begs the question if HCV antibodies have the ability to propagate disease activity independent of SVR. Absence of glomerular disease, lack of Hypocomplementemia and negative rheumatoid factor are other unique features to our case in the setting of pulmonary involvement is also unique to our case. (1,2,3). Our patient also had a favorable outcome with plasmapheresis and steroids alone. Treatment of DAH in the setting of MC is unclear due to the uncommon nature of the diagnosis. Steroids, Rituximab and plasmapheresis have been tried in varying combinations. Our patient declined therapy with Rituximab when presented with the possibility of relapse with HCV.