In contrast to the panarteriitis nodosa macroform, the lung is frequently involved in p-ANCA-positive microvasculitis. Alveolar capillaritis, which may improve under immunosuppressive therapy, is a characteristic feature of this microvasculitis. We report on an 82-year-old patient who was admitted to the hospital because of severe hemoptysis due to microvasculitis. He died 3 weeks later despite therapy with steroids and cyclophosphamide. At autopsy alveolocapillary microaneurysms were found that may be residues of alveolar capillaritis.