Abstract
A 48-year-old female with anti-neutrophilic cytoplasmic antibody (ANCA)-associated vasculitis, initially responded well to standard therapy but later presented with diffuse alveolar hemorrhage (DAH), simulating disease relapse. Following renal remission with standard immunosuppressive therapy, the patient exhibited fever, hemoptysis, and declining renal function, suggestive of a relapse. Bronchoscopy revealed DAH, raising concern for vasculitis exacerbation. However, discordant laboratory findings prompted scrutiny, leading to the detection of Strongyloides larvae in bronchoalveolar lavage.