Chronic thrombotic thrombocytopenic purpura masquerading as other disease entities

A 37-year-old woman with a chief complaint of nausea, headache and, prolonged menses was diagnosed with thrombotic thrombocytopenic purpura based on a peripheral smear with active microangiopathic hemolytic anemia and a platelet count of 4,000/mm3. Her past medical history was significant for several conditions including multiple sclerosis, Bell's palsy, Raynaud's syndrome and HELLP syndrome. In retrospect, it appears that this patient's clinical history was most consistent with one unifying diagnosis, chronic thrombotic thrombocytopenic purpura. Physicians should search for the elusive clinical and laboratory clues for chronic thrombotic thrombocytopenic purpura that can masquerade as other disease entities.