BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is a rare hematologic disorder resulting in hemolysis of red blood cells, consumption of platelets, and occlusion of microvasculature. Malignant hypertension is the clinical syndrome of severe elevations in blood pressure and funduscopic hypertensive retinopathy, including bilateral flame-shaped hemorrhage and papilledema.

CASE REPORT: We describe the case of a 63-year-old man who presented with features of TTP and malignant hypertension treated with plasma exchange and developing end-stage renal disease.

CONCLUSIONS: Given the diagnostic uncertainty at presentation, clinicians should quickly intervene to control hypertension and institute plasma exchange as needed.

Keywords: Blood Pressure - physiology, Biopsy, Diagnosis, Differential, Hypertension, Malignant - physiopathology, Purpura, Thrombotic Thrombocytopenic - physiopathology