Large artery vasculopathy in HIV-positive patients: Another vasculitic enigma

Citation
R. Chetty et al., Large artery vasculopathy in HIV-positive patients: Another vasculitic enigma, HUMAN PATH, 31(3), 2000, pp. 374-379
Citations number
12
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Research/Laboratory Medicine & Medical Tecnology","Medical Research Diagnosis & Treatment
Journal title
HUMAN PATHOLOGY
ISSN journal
0046-8177 → ACNP
Volume
31
Issue
3
Year of publication
2000
Pages
374 - 379
Database
ISI
SICI code
0046-8177(200003)31:3<374:LAVIHP>2.0.ZU;2-6
Abstract
Human immunodeficiency virus (HIV) infection has impacted on all the system s of the body, and the cardiovascular system is no exception, with small to medium-sized vessel vasculitis being most frequently described. We present 16 HIV-positive patients with large vessel disease consisting of either an eurysms (often multiple) or occlusive disease. Nine men and 7 women ranging in age from 18 to 38 years presented with rupture of aneurysm, transient i schemic attacks, hypertension, ischemia to the lower extremity, or a mass a t the site of the aneurysm. Eight patients had 1 aneurysm, 2 had 2 lesions, and the remaining 6 cases had from 3 to 7 aneurysms. Arteries affected inc luded the common carotid, abdominal aorta, common iliac, femoral, and popli teal. Three patients had intercurrent infections, but none had any obvious infective vascular lesion. Only 1 patient had a positive TPHA test for syph ilis. Microbiologic culture of both blood and thrombus contents was positiv e for Staphylococcus aureus in 1 case; no other organisms were cultured. Th e key histological features were within the adventitia: leukocytoclastic va sculitis of the vasa vasora and periadventitial vessels, proliferation of s lit-like vascular channels, chronic inflammation, and fibrosis. There was a ssociated medial fibrosis with loss and fragmentation of muscle and elastic tissue. Intimal changes consisted of duplication and fragmentation of the internal elastic lamina with calcification, Atheroma and marked intimal thi ckening were not evident. We believe that the occurrence of this large vess el vasculopathy (mainly aneurysmal) often with multiple lesions in young HN -positive patients, is characteristic of possible infective or immune compl ex origin, with leukocytoclastic vasculitis of vasa vasora and periadventit ial vessels being pivotal in many cases. Copyright (C) 2000 by W.B. Saunder s Company.