A 33-year-old woman was seen with fever, confusion, and respiratory distress. A diagnosis of thrombotic thrombocytopenic purpura (TTP) was made when renal failure, microangiopathic hemolytic anemia, and thrombocytopenia subsequently developed. An open kidney biopsy confirmed the clinical diagnosis. The patient initially was seen with the roentgenographic and clinical appearance of pulmonary hemorrhage, which was confirmed histologically and, to our knowledge, previously has not been associated with TTP.