Background : Alveolar hemorrhage is a rare, but serious manifestation of SLE. It may occur early or late in disease evolution. Extrapulmonary disease may be minimal and may be masked in patients who are already receiving immunosuppression for other symptoms of SLE. The capacity of AH to occur and recur despite ongoing immunosuppressive therapy is emphasized. Early aggressive management with high-dose steroids and intravenous pulses of Cyclophosphamide. Objectives: To describe our experience with alveolar hemorrhage in patients with Systemic lupus erythematosus. Methods: All the records of SLE patients who had pulmonary hemorrhage between 2000 and 2008 were reviewed. Patients: Seven patients with SLE admitted with nine episodes of AH These patients have the inclusion criteria of AH ; their age ranging from 17 to 35 years and disease duration ranging from 4 to 48 months. For all study subjects, the pertinent demographic, clinical, laboratory, histologic, therapeutic and outcome data were abstracted and chest x-ray reviewed. The disease activity was assessed using SLEDAI. Results: All patients were females. Mean age at the time of AH was 23 years. Mean duration of SLE was 2 years. AH occurred within 4 months of SLE onset in two patients. All patients presented with hemoptysis, new pulmonary infiltrates and hemoglobin drop. Glomerulonephritis was the most common extrapulmonary SLE manifestation (85%). Initial treatment included IV methylprednisolone in all cases (100%), with Cyclophosphamide in four episodes. Plasmapheresis (one session) was added in only one episode. Survival rate was 14%. Conclusion: Alveolar hemorrhage is a rare but lethal complication of SLE and represents a remarkable challenge. It should be diagnosed promptly in the SLE patient with falling red cell indicies and new infiltrates on chest radiograph. It occur in variety of active disease and lupus nephritis is most associated manifestation. Alveolar hemorrhage frequently recure despite ongoing immunosuppression. Early treatment with I.V methylprednisolone and I.V Cyclophosphamide should be instituted for a better outcome.