Thrombotic thrombocytopenic purpura (TTP) is typically characterized by the 
symptomatic pentad of fever, thrombocytopenia, microangiopathic hemolytic 
anemia, neurologic abnormalities, and renal failure. Atypical TTP is the 
diagnosis used to describe the subset of patients with TTP who present with 
symptoms that deviate from the classic pentad. We report a case an 86-year-old 
woman who presented to the emergency department complaining of chest pain for 
one day. She was reportedly on antibiotics for sinus infection. Physical 
examination revealed multiple bilateral superficial hematomas, predominantly on 
her extremities. On admission, her lab values were as follows: platelet count of 
6,000/cubic millimeter, hemoglobin of 10.4 grams/deciliter, leukocyte count of 
5100 cells/cubic millimeter, total bilirubin of 2.3 milligrams/deciliter, and 
troponin-I of 5.190 nanograms/milliliter. Peripheral blood smear was normal and 
did not reveal any schistocytes. The patient was admitted to the intensive care 
unit with a diagnosis of a non-ST-elevation myocardial infarction and a presumed 
diagnosis of immune thrombocytopenic purpura from antibiotic use. She was 
treated with intravenous solumedrol and a high-intensity statin. On the third 
day of her admission, the patient's mental functioning deteriorated and was 
intubated to protect her airway. A second peripheral smear revealed 
schistocytes, and subsequent laboratory studies supported the diagnosis of TTP. 
Plasma exchange therapy was planned. However, the patient succumbed to cardiac 
arrest before it could be initiated. The diagnosis was later confirmed with an 
ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 
motif, member 13) assay.  This case serves as an example of one of the many ways 
in which TTP can present, and emphasizes the importance of considering TTP as a 
differential diagnosis.