Syncope as the Initial Presentation of Takayasu Arteritis in a 57-Year-Old Female: A Case Report and Literature Review.

Takayasu arteritis (TA) is a rare chronic granulomatous large-vessel vasculitis predominantly affecting the aorta and its major branches, leading to stenosis, occlusion, or aneurysm formation. It typically presents in young women, though atypical cases can occur in older adults. Diagnosis is often delayed owing to nonspecific symptoms and a lack of reliable biomarkers. We report a case of a 57-year-old woman who presented with recurrent syncope, dizziness, and chest tightness. Physical examination revealed a significant blood pressure discrepancy between arms and carotid bruits. Although erythrocyte sedimentation rate (ESR) was normal, other inflammatory markers were elevated. Angiography and computed tomography angiography demonstrated multi-vessel involvement, including subtotal occlusion of the right subclavian artery, complete occlusion of the left subclavian artery, and stenosis of the right vertebral artery and abdominal aorta. The patient met the 2022 American College of Rheumatology classification criteria for TA. Treatment with glucocorticoids and cyclophosphamide resulted in symptomatic improvement, with no recurrence during a six-month follow-up. This case underscores that syncope can be a rare initial manifestation of TA, and normal ESR does not exclude active disease. Thorough clinical evaluation and vascular imaging are essential for timely diagnosis and management to prevent serious complications.