We present a case of acute myeloid leukemia (AML) with myelodysplasia-related 
changes that presented as thrombotic thrombocytopenic purpura (TTP). Our patient 
presented with the classic pentad of TTP symptoms: anemia, thrombocytopenia, 
fever, elevated creatinine, and altered mental status. After a failure to 
respond to plasmapheresis therapy, we proceeded with a bone marrow biopsy and 
fluorescent in situ hybridization, which supported formal diagnosis of AML with 
myelodysplasia-related changes. Our case is an extremely rare presentation of a 
rare condition, as there have been no reported cases of AML with 
myelodysplasia-related changes presenting as TTP.