Pulmonary alveolar hemorrhage (PAH) is a rare and often fatal presenting feature of systemic lupus erythematosus (SLE). Reported mortality rates are extremely high, 70% to 90%. Death frequently occurs within the first several days of the hemorrhage. The hospital records of all inpatients with PAH and SLE between April 1986 and May 1991 at the Hospital of the University of Pennsylvania were reviewed. The complete resolution of PAH and the 75% survival rate found in this study is in marked contrast to previous reports. This experience suggests that patients with PAH and SLE may have a better prognosis than previously reported.