Concomitant ischemic stroke and myocarditis as the initial clinical presentation of Takayasu arteritis

Tayakasu arteritis (TA) is a chronic large-vessel systemic vasculitis more frequent in women. The pathogenesis of TA is not fully understood. Due to its silent and heterogenous nature, it is a challenging diagnosis, with no specific diagnostic tests. We report the case of a 45-year-old woman presenting with a concomitant ischemic stroke and myocarditis as an atypical presentation of Takayasu arteritis, revealing its heterogeneous nature. The pre-existent myocardial scar and dilated cardiomyopathy are is a reminder of how silent yet aggressive this vasculitis can be and the need of for high level of suspicion to detect and treat Takayasu arteritis early, avoiding late consequences. Corticosteroids (0.5-1.0mg/kg/day) are the mainstay treatment associated with steroid-sparing drugs, such as methotrexate or azathioprine.