We report a case of thrombotic thrombocytopenic purpura refractory to plasma exchange treatment. In bone marrow examination non hematopoetic cell groups have seen. But the primary tumor could neither be located endoscopically nor in imaging examinations. Upon the bone marrow biopsy confirm the adenocarcinoma metastasis an objective improvement have achived in the blood picture after polychemotherapy. (C) 2013 Elsevier Ltd. All rights reserved.