Clinical thrombotic thrombocytopenic purpura (TTP) is characterized by a pentad 
of microangiopathic hemolytic anemia, thrombocytopenia, neurological symptoms, 
renal involvement, and fever. A case of TTP in which early symptoms and signs 
were suggestive of ischemic heart disease, renal failure, and severe 
thrombocytopenia developed to a rapid outcome of death. The postmortem 
examination revealed coronary artery microthrombi, typical of TTP. The clinical 
presentation of this TTP was atypical: severe thrombocytopenia, striking renal 
and CNS symptoms were present, but fever and anemia were not present. Thrombotic 
thrombocytopenic purpura is an uncommon condition that carries a high fatality 
rate if untreated. Awareness of this syndrome and its high risk of sudden death 
underlines the importance of rapid diagnosis and treatment.