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[True aneurysm of the ascending aorta in HIV disease]
K Boggian1, H J Leu, J Schneider
1Medizinische Klinik A, Kantonsspital St. Gallen.
Insights
A rare case of ascending aortic aneurysm in an HIV-1 positive patient was successfully treated with emergency graft implantation. The aneurysm was linked to granulomatous giant cell mesaortitis, highlighting a potential HIV-associated cardiovascular complication.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Pathology
Background:
- A 31-year-old male with a 5-year history of Human Immunodeficiency Virus type 1 (HIV-1) infection, acquired through intravenous drug abuse, presented with a true aneurysm of the ascending aorta.
- The patient initially refused elective aneurysmectomy, opting for monitoring.
Observation:
- Serial imaging (computerized tomography and echocardiography) over 8 months revealed progressive dilatation of the ascending aortic aneurysm.
- In February 1992, a significant increase in aneurysm size accompanied by severe thoracic pain necessitated emergency surgical intervention.
Findings:
- Emergency graft implantation was performed to address the rapidly expanding aneurysm.
- Histopathological examination of the resected aortic tissue showed granulomatous giant cell mesaortitis, indicating an inflammatory process within the aorta.
- The patient experienced an uneventful postoperative recovery with no immediate cardiovascular symptoms.
Implications:
- This case highlights granulomatous giant cell mesaortitis as a potential, albeit rare, cardiovascular manifestation in patients with HIV-1 infection.
- The findings underscore the importance of considering HIV-associated vasculitis in the differential diagnosis of aortic aneurysms, particularly in at-risk populations.
- While the patient survived the aortic surgery, his long-term prognosis was ultimately determined by opportunistic infections secondary to HIV-1, leading to his death 25 months post-surgery.
Abstract:
A 31-year-old male who presented with a true aneurysm of the ascending aorta had for 5 years been seropositive for HIV-1 following intravenous drug abuse. Elective aneurysmectomy was refused. Controls by computerized tomography and echocardiography gave evidence of a progressive dilatation during the following 8 months. In February 1992 a further increase of the aneurysm with severe thoracic pain necessitated an emergency graft implantation. Histopathology of the resected aorta revealed a granulomatous giant cell mesaortitis. The postoperative course was uneventful and the patient remained free of cardiovascular symptoms, but died 25 months later due to multiple HIV-associated opportunistic infections. The differential diagnosis (Marfan's syndrome, vasculitis due to tuberculosis, syphilis and other infectious agents, rheumatological diseases, HIV-associated vasculitis) and the etiopathological considerations are discussed.