Boggian K, Leu H J, Schneider J, Turina M, Oertle D
Medizinische Klinik A, Kantonsspital St. Gallen.
Schweiz Med Wochenschr. 1994 Nov 19;124(46):2083-7.
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.
一名31岁男性，因升主动脉真性动脉瘤前来就诊。该患者曾因静脉注射毒品感染HIV-1达5年，其拒绝接受择期动脉瘤切除术。计算机断层扫描和超声心动图检查显示，在接下来的8个月中动脉瘤呈进行性扩张。1992年2月，动脉瘤进一步增大并伴有严重胸痛，遂进行了紧急血管移植术。切除主动脉的组织病理学检查显示为肉芽肿性巨细胞中层主动脉炎。术后恢复顺利，患者未出现心血管症状，但25个月后因多种与HIV相关的机会性感染而死亡。文中讨论了鉴别诊断（马凡综合征、结核、梅毒及其他感染因子所致血管炎、风湿性疾病、HIV相关血管炎）及病因学方面的考虑。
