Type IV Takayasu Arteritis Presenting as a Late-Onset Hypertensive Emergency and Transient Ischemia: A Case Report Highlighting Diagnostic Challenges

A 69-year-old female patient presented with a hypertensive emergency and recurrent episodes of left upper extremity paresthesia. While initial cerebrovascular imaging was negative, physical examination revealed a significant blood pressure discrepancy between the upper extremities. Subsequent computed tomography angiography of the abdomen identified abnormal circumferential wall thickening of the infrarenal abdominal aorta extending into the common iliac arteries, consistent with aortitis. Additionally, duplicate left renal arteries were noted, with severe stenosis of the posterior artery driving the hypertensive crisis. These findings supported a diagnosis of Type IV Takayasu arteritis, an exceptional presentation in a patient of advanced age with normal inflammatory markers. The patient was stabilized with intravenous antihypertensive therapy and transferred for multidisciplinary management. This case underscores the importance of considering large-vessel vasculitis in the differential diagnosis of elderly patients presenting with unexplained hypertensive emergencies, as reliance on age demographics or inflammatory markers may delay accurate diagnosis.