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Thrombotic microangiopathies (TMAs) that primarily present with acute kidney injury, such as Shiga-toxin mediated hemolytic uremic syndrome (ST-HUS) and complement-mediated TMA (CM-TMA, also known as atypical HUS) are not well-described in adults. CM-TMA is an uncommon condition caused by complement dysregulation. It is characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia and acute renal failure. We present a unique case of CM-TMA that presented with extensive arterial and venous thrombi. A 46-year-old male with past medical history of transient ischemic attack presented with 2 weeks of cough with hemoptysis and dyspnea. His vital signs included: blood pressure 90/60 mmHg, respiratory rate 22 breaths/min and heart rate 140 beats/min. Physical exam was notable for decreased breath sounds in the left lung. Labs were significant for …