Recognizing thrombotic thrombocytopenic purpura beyond the pentad

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening hematologic disorder characterized by widespread microvascular thrombosis. Classic clinical features include: fever, microangiopathic hemolytic anemia, thrombocytopenia, renal dysfunction, and neurologic abnormalities, such as altered mental status, confusion, or coma. Prompt recognition and initiation of plasma exchange therapy in the emergency department (ED) are essential for patient survival. We report a case of a 40-year-old female who presented to the ED with a vague complaint of joint pain and no remarkable findings on physical examination. Despite the absence of hallmark features, further evaluation revealed a diagnosis of TTP. This case underscores the diagnostic challenge posed by atypical TTP presentations and highlights the importance of maintaining a high index of suspicion, even in the absence of classic clinical signs.