eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2021-07-12 9 11 535 537 10.12691/ajmcr-9-11-4 AJMCR20219114 article Caleb V Wutawunashe 1 Kourosh Shargani Kshargani@northwell.edu 1 Anu Menon 1 Northwell Lenox Hill Hospital, New York, NY. 100 E 77th St, New York, NY 10075, USA Granulomatosis with polyangiitis is a vasculitis that affects small to medium sized blood vessels in the lungs and kidneys. Alveolar hemorrhage is often initially misdiagnosed as pneumonia and treated incorrectly, leading to higher adverse outcomes in patients with undiagnosed vasculitis. We describe a case of a 68-year-old female who presented to our institution and was initially diagnosed and treated for community acquired pneumonia, however, after a protracted clinical course with no improvement in her respiratory status, she underwent a bronchoscopy that revealed pulmonary alveolar hemorrhage, a manifestation of underlying granulomatosis with polyangiitis. http://pubs.sciepub.com/ajmcr/9/11/4/ajmcr-9-11-4.pdf granulomatosis with polyangiitis pulmonary alveolar hemorrhage pneumonia granulomatosis with polyangiitis