Pulmonary hemorrhage is a feature of several immune and idiopathic disorders. The specific etiology of this disease is determined by clinical, serological and renal pathology. Microscopic polyarteritis nodosa is a vasculitis of small vessels which is characterized by involvement of the lung, kidney and skin in young individuals. Its clinical manifestations differ from classical polyarteritis nodosa. It should be considered in differentiation of recurrent alveolar hemorrhage and hematuria. We reported a case of microscopic polyarteritis nodosa which was confirmed by renal biopsy and positive serum antineutrophil cytoplasmic antibody, associated with recurrent alveolar hemorrhage and hematuria.