Dyspnea in Takayasu arteritis - an ordinary cause with an extraordinary link

Takayasu arteritis (TA) poses a diagnostic challenge as it may have a myriad of clinical presentations. Dyspnea, as an index presentation in TA, may be secondary to the involvement of the aorta, myocardium, and/or the pulmonary vessels, or can present as a manifestation of pulmonary infection with tuberculosis. Significant lymphadenopathy cannot be attributed to TA and serves to point towards a different diagnosis or concomitant infection. Tuberculosis has been associated with TA and has considerable pathogenic and therapeutic implications. We present a case of a young female with extensive intra-thoracic tubercular lymphadenopathy compressing the trachea and right main bronchus resulting in dyspnea. The patient was subsequently found to have active TA and improved after treatment with anti-tubercular therapy and steroids. We review the causes of dyspnea and mediastinal lymphadenopathy in a patient with TA.