Abstract
A 28 year-old female with congenital human immunodeficiency virus infection presented with microangiopathic hemolytic anemia and thrombocytopenia secondary to multi-drug resistant Pseudomonas aeruginosa pulmonary infection. Initial management for thrombotic thrombocytopenic purpura (TTP) was discontinued when normal ADAMTS13 activity was found. There are several infectious etiologies that can exhibit microangiopathic hemolytic anemia and thrombocytopenia mimicking TTP including P. aeruginosa. This case highlights the importance of following guidelines regarding dual antibiotic coverage for P. aeruginosa infection as antibiotic resistance can develop during the course of treatment.