Takayasu vasculitis (TAK) is a form of large vessel vasculitis clinically manifesting as pulseless disease or hypertension. It is more common in South East Asia and Japan, India, and Mexico¹. It is increasingly being recognized due to increased awareness among the medical fraternity and better imaging modalities. Undetected hypertension, pulselessness, and syncope are more common symptoms, and presentation during pregnancy is unusual but, unfortunately, might lead to bad pregnancy outcomes with eclampsia. Once diagnosed in pregnancy, it would be difficult to control BP and prevent the inevitable miscarriage. Recent evidence supports the use of tocilizumab for inducing remission in Takayasu arteritis. We report this rare case of vasculitis presenting in pregnancy as malignant hypertension. A 20-year-old pregnant woman (45 days) presented with a headache and found BP 180/110. She had a history of intermittent claudication of her legs for the past three years but was not evaluated. She had two missed abortions. During the examination, apart from high BP, pulses were felt normally, no murmurs in cardiac auscultation, but she had abdominal bruit (renal vessels), and other systems were normal. Her pregnancy test was positive in urine, and serum HCG (human chorionic gonadotrophin) levels were 5643 m IU /ml. Blood investigations showed anemia (Hb 9.8mg/dl) elevated CRP (12mg/L), ESR (60mm/hr). White blood cell count (6200/cu mm), ECG showed left ventricular hypertrophy. ECHO showed dilated ascending aorta, mild Aortic regurgitation, and left ventricular hypertrophy. Ultrasound abdomen showed no ascites or organomegaly. Doppler of renal vessels showed features of narrowing of renal arteries. (severe stenosis on the right and left side showed normal caliber). Unfortunately, she had to undergo termination of pregnancy (high BP).She then had a CT angiogram showing features of Takayasu arteritis with type 5 pattern - She had methylprednisolone induction followed by Tocilizumab 400 mg monthly three doses. Once remission was achieved, she had recanalization by percutaneous transluminal angioplasty with stenting of infrarenal abdominal aorta & right renal artery. Her BP was 130/70 and 110/80 in the right and left upper limbs following the angioplasty. She is currently maintained on aspirin and telmisartan. Awareness of causes of high BP, inputs by radiologists, cardiologists, rheumatologists, and understanding by the patient and family helped achieve a good outcome, albeit the miscarriage. The appropriate intervention helped to control the BP and thereby to achieve remission of vasculitis early.