Celiac Artery Dissection in an HIV-Positive Patient With Cocaine Use: A Rare Vascular Emergency

Celiac artery dissection is a rare vascular emergency that typically occurs in middle-aged men with risk factors like hypertension or atherosclerosis. We report a unique case of spontaneous celiac artery dissection in a patient with HIV infection and recent cocaine use. The patient presented to the emergency department with acute epigastric pain shortly after cocaine ingestion. Contrast-enhanced CT angiography confirmed an isolated dissection of the celiac artery without aortic involvement. Inpatient management was conservative, including strict blood pressure control, analgesia, and close monitoring, with input from cardiology and vascular surgery. The patient remained hemodynamically stable and was managed non-operatively, with plans for outpatient follow-up and risk-factor modification. This case highlights the potential synergistic role of cocaine's hemodynamic effects and HIV-associated vasculopathy in precipitating visceral arterial dissection, and underscores the importance of considering visceral artery dissection in patients with atypical risk factors. The outcome in this case was favorable with medical management alone.