Thrombotic thrombocytopenic purpura (TTP, Moschcowitz disease) is characterized 
by thrombotic microangiopathy leading to microvascular occlusion and ischemic 
dysfunction of various organs including the brain. In the course of the rare 
disease most patients develop neurological symptoms of varying severity and 
characteristics. The case presented is that of a 34-year-old female patient with 
profound thrombocytopenia, anemia and rapidly progressive neurological 
deterioration into coma with normal result of brain imaging. TTP was recognized 
on the basis of hematological analysis. The initiated steroid therapy and plasma 
exchange failed to prevent the turbulent course of disease in the patient, who 
died exhibiting symptoms of multiple organ failure caused by thrombotic 
microangiopathy. TTP remains to be a diagnostic challenge, particularly in the 
case of atypical symptoms or when neuroimaging and laboratory results are 
inconclusive. Before using the corticosteroids and plasma exchange, TTP had a 
case fatality rate of approx. 90% (Podolak-Dawidziak, 2013). Nowadays recovery 
is possible when vigorous treatment is introduced early in the course of this 
disease.