Spontaneous aortic rupture due to human immunodeficiency virus-associated vasculitis: A lesson learnt

Abstract

Case descriptionWe report a case of a 67-year-old male admitted to our services with a spontaneous contained rupture of the suprarenal abdominal aorta. Four months prior to his presentation to the vascular services, this gentleman was diagnosed with HIV and was subsequently reviewed by the infectious disease physicians. His CD4 count at that time was 128 (7.4%) and it was noted that he had had a reactivation of Herpes zoster suggestive of immunosuppression. It was thus decided to start him on highly active antiretroviral therapy (HAART) commencing with Combivir (lamivudine and zidovudine) and efavirenz. On routine screening, he was negative for both Hepatitis B and C; however, his venereal disease research laboratory serology test was positive, a diagnosis of latent syphilis was made and a course of benzylpenicillin was commenced.Four months post-HIV diagnosis, he presented as an emergency admission with right upper and lower limb weakness, slurred speech and right facial droop. In the first week of that admission, he developed sudden severe lower back pain and worsening of his lower limb weakness. An MRI scan was performed demonstrating an infiltrating mass at the level of the juxtarenal aorta and thought initially to be consistent with an infiltrating Kaposi's sarcoma. A CT angiogram was obtained and this confirmed the mass to be a suprarenal aortic haematoma with the aortic rupture site located immediately below the origin of the superior mesenteric artery and involving the aorta at the level of the right renal artery (Figure 1).He underwent an endovascular repair using a right renal chimney graft to extend the landing zone for an aortic exclusion graft. The aortic main body graft comprised a Talent TM (Medtronic, Santa Rosa, CA, USA) aortic extension graft (AXF3030W28AX: 30 mm  28 mm). The right renal artery 'chimney graft' was a Viabahn TM (Gore Medical, Flagstaff, AZ, USA) endoprosthesis (PAH080502: 8 mm  50 mm  120 mm) deployed via the left brachial