A 36-year-old woman with ulcerative colitis presented with progressive chest pain and neurovegetative symptoms. The electrocardiogram showed ST segment elevation in the inferior wall. The patient had a previous history of fatigue and night sweats. She underwent coronary angiography, which revealed severe disease of two coronary vessels, with successful primary angioplasty of the culprit vessel. Aortitis was suspected, which led to additional studies, among which a slight elevation of inflammatory activity indices stood out, and a computed tomography angiography showed periaortic fibrotic thickening and significant stenosis in multiple arteries, suggesting Takayasu vasculitis. She was treated with prednisone and methotrexate and underwent delayed myocardial revascularization surgery with good results. This case highlights the complexity of Takayasu arteritis, its possible association with ulcerative colitis, and the importance of early diagnosis for adequate management.