We presented a 27 year old male with history of anxiety and ADHD who presents for nausea, vomiting and dark urine for 3 days. 3 days prior he was in his normal sate of health until after eating a vegetarian curry dish, and he developed emesis the morning after. He drinks 3-4 beers per night, does not have any drug use or tobacco use, no recent travel, no known sick contacts and not sexually active and his only med is sertraline daily. On exam he is noted to be pale with pale palms, pale conjunctiva and scleral icterus with mild petechiae noted on his palate. His labs were significant for a low hemoglobin, elevated Cr to 4.79 and a peripheral smear with schistocytes. His d-dimer was elevated, DAT negative, retic count of 6.1% with absolute being consistent with hyperproliferative state state and he was diagnosed with MAHA. He was started on dialysis and prednisone and ADAMTS-13 returns low with inhibitor positive and final dx of acquired TTP thought to be due to gastroenteritis.