Calciphylaxis on the background of immune thrombocytopenic purpura (ITP) has never been described. The pathogenesis of calciphylaxis is complex and not fully understood as yet. ITP has a complex pathogenesis that leads to bleeding or thrombotic events. Although ITP is treatable and reversible, calciphylaxis on the other hand, responds poorly to treatment and carries high mortality and morbidity. We present a case of a 56-year-old lady with end-stage renal disease with ITP, who complained of 1-month history of painful necrotic patches over the thighs. Due to delayed diagnosis, the patient deteriorated and passed away despite aggressive multidisciplinary approach. This case highlights the importance of early recognition of the increased thrombotic risk in an end-stage renal failure patient with poor phosphate control and ITP.