Complex vasculitic overlap: temporal arteritis complicating suspected neuro-behçet disease with recurrent ischemic injury.

Vasculitic disorders can present with overlapping clinical and radiologic features, complicating diagnosis and management. Differentiating between Behçet disease-associated vasculitis and giant cell arteritis (GCA) is particularly challenging but essential for appropriate treatment. A 49-year-old woman with a history of recurrent venous and arterial thrombosis and suspected Behçet disease presented with severe temporal headache and acute focal neurological deficits. Neuroimaging revealed a chronic ischemic infarct with occlusion of the right internal carotid artery and collateral circulation, without evidence of active intracranial vasculitis. Laboratory studies demonstrated elevated inflammatory markers. Vascular imaging showed inflammatory changes involving the superficial temporal artery. Based on the presence of temporal headache, raised inflammatory markers, imaging evidence of superficial temporal artery inflammation, and exclusion of alternative causes, a diagnosis of giant cell arteritis was considered most likely in the setting of a complex vasculitic background. High-dose systemic corticosteroid therapy was initiated. The patient showed marked clinical improvement following treatment, with resolution of headache and stabilization of neurological deficits. She continues under multidisciplinary follow-up for monitoring of disease activity and thrombotic risk. This case highlights the diagnostic challenges of overlapping vasculitic syndromes and emphasizes the importance of integrating clinical findings, imaging results, and therapeutic response in guiding management of suspected giant cell arteritis.