Takayasu arteritis manifesting as pyrexia of unknown origin and massive splenomegaly

Takayasu arteritis (TA) is a rare large-vessel granulomatous vasculitis predominantly affecting young women. We report the case of a male patient in his early 20s presenting with a three-month history of pyrexia of unknown origin (PUO), significant weight loss, a left carotid bruit and massive splenomegaly, culminating in a diagnosis of Type V TA. The presentation was atypical in several respects: prolonged high-grade fever, marked splenomegaly and male sex are all uncommon in TA.CT angiography demonstrated concentric mural thickening with stenotic involvement of the aorta and its major branches. In conjunction with markedly elevated inflammatory markers, a diagnosis of Type V TA was established. The patient became apyrexial with resolution of constitutional symptoms following initiation of immunosuppressive therapy. This case highlights the imperative to consider TA in atypical clinical contexts, including male sex, PUO and massive splenomegaly. It underscores the value of systematic vascular evaluation in unexplained chronic pyrexia.