TRUE ANEURYSM OF ASCENDING AORTA IN HIV-I NFECTION

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 intraveno us drug abuse. Elective aneurysmectomy was refused. Controls by comput erized tomography and echocardiography gave evidence of a progressive dilatation during the following 8 months. In February 1992 a further i ncrease of the aneurysm with severe thoracic pain necessitated an emer gency graft implantation. Histopathology of the resected aorta reveale d 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, rheumatolog ical diseases, HIV-associated vasculitis) and the etiopathological con siderations are discussed.