Cardiac arrest as the first presentation of Takayasu arteritis in a young adult: a case report.

Background: Sudden cardiac arrest (SCA) is rare in young individuals, being typically caused by inherited cardiomyopathies or electrical disorders. However, less common aetiologies should not be overlooked. Case summary: A male in his twenties suffered an aborted SCA. Initial investigations revealed significant triple-vessel coronary artery disease leading to urgent surgical revascularization. Macroscopically, diffuse coronary luminal narrowing due to marked wall thickening was observed. Histopathology of the right internal mammary artery showed a non-necrotizing vasculitis pattern, which, together with abdominal aorta, mesenteric and iliac artery involvement on computed tomography angiography, supported a diagnosis of Takayasu arteritis. High-dose glucocorticoids were started, resulting in rapid normalization of inflammatory biomarkers. The patient was discharged after 54 days, with programmed administration of anti-tumour necrosis factor-alpha monoclonal antibody adalimumab. Discussion: Takayasu arteritis is a rare vasculitis classically affecting medium- to large-sized vessels, but may involve the coronary tree and ultimately manifest as SCA. This case underscores the diagnostic challenges of young adults presenting with acute coronary syndromes, highlighting the importance of clinical suspicion, histopathological evaluation, and a collaborative approach for a successful outcome.