CASE PRESENTATION: A 56-year-old African American male with no significant PMH was transferred to our center with an altered mental status. The patient reports that he did not have recollection of the events surrounding his admission and he was having difficulty answering questions appropriately. Physical examination was normal. CBC showed normal leukocytes count, anemia, and platelets count of 16,000. Peripheral smear showed reticulocytosis and schistocytes. Chemistry revealed a mildly elevated creatinine, indirect bilirubin and AST. LDH was elevated. Routine chest X-ray revealed a 3 cm left upper lobe lung mass, a finding confirmed with a chest CT. Mass biopsy showed a poorly differentiated adenocarcinoma of the lung. He was started on plasmapheresis which resulted in short-lived improvement. He underwent a left upper lobe lobectomy, after which, he went into complete remission.