A 30-year-old man presented to a nearby hospital with fever and productive cough in April 2009. Chest CT revealed bilateral consolidation with cavity, accompanied with diffuse micronodules, reticular shadow, and ground-glass opacity predominant in lower lobes. Because Mycobacterium kansasii was isolated from sputum culture, antituberculous chemotherapy was initiated. His dyspnea on exertion and ground-glass opacity in high resolution CT (HRCT) gradually worsened from January 2010, and he visited our hospital for further examination in April, 2010. Bronchoalveolar lavage fluid appeared hemorrhagic, and many hemosiderin-laden macrophages were found in it. Surgical lung biopsy demonstrated alveoli containing many hemosiderin-laden macrophages. Thickening of alveolar walls and deposition of hemosiderin to the interstitial tissue were also noted. These findings were consistent with pulmonary hemosiderosis. With no other causes for recurrent pulmonary hemorrhage, he was ultimately diagnosed with idiopathic pulmonary hemosiderosis. Since the disease is quite rare in persons over 30 years of age, this case is considered to be worth reporting. When progressive structural damage of pulmonary alveolus was observed, an early induction of systemic glucocorticoids would be favorable to control the progression of pulmonary fibrosis.