CASE PRESENTATION: A 25 year old Caucasian male was admitted to the hospital with acute pulmonary edema, acute kidney injury and anemia. Initial laboratory results showed microcytic anemia with thrombocytopenia. Transthoracic echocardiography revealed hypokinetic left ventricle with EF 30%.Two days later he was started on hemodialysis. Head CT, lumbar puncture, WBC with differential and bone marrow biopsy were all normal. Due to persistent agitation and fever on day 5, he underwent MRI brain which showed numerous sub-acute infarcts in bilateral frontal, parietal, occipital and temporal lobes. A venous Doppler of the lower extremities showed bilateral deep venous thromboses. Immunology workup revealed a positive ANA at 1:180, as well as positive lupus anticoagulants. Patient was started on plasmapheresis, steroids, and anticoagulation with marked clinical improvement.