atypical presentation of paroxysmal nocturnal hemoglobinuria treated by eculizumab a case report rationale paroxysmal nocturnal hemoglobinuria pnh is a nonmalignant acquired hematopoietic stem cell disease which can be revealed by hemolytic anemia thromboembolism or bonemarrow failure thrombosis can occur at any site but coronary thrombosis is extremely rare controlled trials have demonstrated that eculizimab an inhibitor of the terminal complement cascade was able to reduce both hemolysis and thrombosis but its efficacy in cases of pnh with coronary thrombosis is unknownpatient concerns and diagnoses we report herein the unusual case of a 73yearold patient presenting with recurrent coronary syndromes without associated stenosis fever marked inflammatory syndrome and anemia leading to a delayed diagnosis of pnhintervention and outcomes eculizumab allowed the resolution of fever and inflammation and prevented further thromboembolismlessons this case emphasizes the importance of performing aflow cytometry test for pnh in front of unusual or unexplained recurrent thromboses thromboses as observed in our case may be associated with fever and marked inflammation this case also provides useful information on eculizumab ability to prevent further thromboembolism in pnh patients with a medical history of arterial thrombosis