Thrombotic microangiopathy (TMA) is a rare, life-threatening condition involving microvascular occlusion in multiple systems ([1]). B-cell depletion therapy with RTX has shown efficacy in several open-labelled studies, but failed to demonstrate benefits in two randomized trials of non-LN and LN patients ([3]). However, the European League Against Rheumatism stated that RTX should be considered in organ-threatening, refractory lupus ([4], [5]), and no guidelines for the treatment of TMA in the patient with LN have been established. [Extracted from the article]