Henoch-Sch nlein purpura is an immunologically mediated systemic vasculitis of small blood vessels that primarily involves the skin, gastrointestinal tracts, joints, and kidneys. Henoch-Sch nlein purpura is a common vasculitic disease of childhood. It is diagnosed by characteristic clinical manifestations: nonthrombocytopenic purpura, arthritis or arthralgia, abdominal pain which may be complicated by gastrointestinal hemorrhage, and urinary sediment changes. Pulmonary hemorrhage is a rare complication which occurred predominantly in adolescent and adult according to previously reported cases. We experienced 34-year-old man with Henoch-Sch nlein purpura in whom gastrointestinal bleeding and bilateral, massive, pulmonary hemorrhage developed. He died of respiratory failure. (Kor J Gastroenterol 2000;36:536 - 541)