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Background: Takayasu arteritis, rheumatoid arthritis, and autoimmune hypothyroidism are immune-mediated disorders that rarely coexist in a single patient. Their concurrence represents an important example of polyautoimmunity and may create diagnostic and therapeutic challenges.
Case presentation: A 45-year-old Sudanese woman presented with acute gastrointestinal symptoms and a history of chronic symmetrical inflammatory arthritis affecting the small joints of both upper limbs. Physical examination revealed absent upper-limb pulses, carotid bruits, and diffuse goiter. Laboratory testing demonstrated positive anti-cyclic citrullinated peptide antibodies consistent with rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria. Thyroid function tests revealed markedly elevated TSH and low T4 levels consistent with autoimmune hypothyroidism. Computed tomography angiography showed inflammatory thickening of the aortic arch with occlusion and stenosis of major branches fulfilling the American College of Rheumatology (ACR) criteria for Takayasu arteritis.
Conclusion: This case highlights the importance of recognizing polyautoimmunity and emphasizes the need for multidisciplinary evaluation when vascular, rheumatologic, and endocrine manifestations coexist.