gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

5 in 1: multiple atypical aneurysms in a HIV patient

5 in 1: Multiple atypische Aneurysmata in einem HIV-Patienten

Meeting Abstract

  • M.F. Küpper - University of Freiburg, Department of Medicine, Division of Infectious Diseases, Freiburg, Germany
  • W. Euringer - University of Freiburg, Department of Radiology, Freiburg, Germany
  • J. Thoden - University of Freiburg, Department of Medicine, IFB-Centre of Chronic Immunodeficiency, Freiburg, Germany
  • S. Usadel - University of Freiburg, Department of Medicine, Division of Infectious Diseases, Freiburg, Germany; University of Freiburg, Department of Medicine, IFB-Centre of Chronic Immunodeficiency, Freiburg, Germany; KB Specialized Medical Practice/HIV-Center Freiburg, Germany
  • W.V. Kern - University of Freiburg, Department of Medicine, Division of Infectious Diseases, Freiburg, Germany
  • D. Wagner - University of Freiburg, Department of Medicine, Division of Infectious Diseases, Freiburg, Germany; University of Freiburg, Department of Medicine, IFB-Centre of Chronic Immunodeficiency, Freiburg, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP143

DOI: 10.3205/10kit197, URN: urn:nbn:de:0183-10kit1971

Published: June 2, 2010

© 2010 Küpper et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Introduction: Multiple large vessel aneurysms affecting the aorta and its main branches are a rare HIV-associated complication described predominantly in black patients. The pathogenesis is unclear. Histolopathology usually shows leukocytoclastic vasculitis of the vasa vasora and angiogenesis (proliferation of slit-like channels) in the adventitia (1). We here present the case of a black HIV-infected patient with five large vessel aneurysms in the right superficial femoral and both subclavian arteries as well as in the infra- and suprarenal aorta.

Case report: The male patient (44 years of age, CDC A3, initial HIV diagnosis 8 years earlier, currently CD4 225/µl, suppressed viral load) was admitted to a local hospital for abdominal pain. Diagnostic workup revealed an excentric infrarenal abdominal aneurysm (3x3.4 cm) and a right-sided thoracic mass lesion. He had a history of a stroke at the age of 31, with residual hemiparesis, and of an aneurysm of the right superficial femoral artery (7x7 cm) by-passed 8 years ago. Further work-up identified three more aneurysms: one in the right subclavian artery (representing the initially diagnosed mass lesion), a small left subclavian and a second abdominal aneurysm located suprarenally (1.5x1.5cm). Intracerebral aneurysms were exluded by MRI. The cardiovascular profile was unremarkable, common causes of mycotic aneurysms were excluded. Inflammatory and autoimmune disease markers were negative (except an atypical ANCA on microscopy). FDG-PET-CT was negative, and there were no clinical features of Behēet's vasculitis, Marfan's or Ehlers-Danlos syndrome. All four newly detected aneurysms were successfully treated by endvascular stent graft implantation using a new self-expandible multilayer stent device (MARS). Post-procedure CT scans showed all aneurysms to be mostly excluded from the main circulation with all visceral branches still being perfused. The patient is well on follow-up one month after these procedures.

Conclusions: Multiple aneurysms of large vessels (up to 10 in one patient) have been described mainly in black male HIV patients (2). Diagnosis of an arterial aneurysm in a HIV patient – especially when localized atypically or when diagnosed in black men – should always lead to a thorough work up in search of further aneurysms in need of prophylactic interventions. New self-expandible multilayer stents could become the treatment of choice in locations where visceral branches need to be bridged.