Patient with pulmonary fibrosis had positive ANCA at her initial screening: A 64-year-old woman complained of cough and exertional dyspnea. She had UIP-pattern on chest CT: reticular opacities and honeycombing with basal and peripheral distribution. But her ANCA showed a myeloperoxidase of 196 EU and she was diagnosed with MPA. She was then treated with corticosteroids and cyclophosphamide and had a good outcome.