Page 223 - AIDSBK23C
P. 223
Page 223
individuals, and can be manifested as retinal microangiopathic syndrome with the presence of
multiple cotton wool. Plasma endothelin-1, a potent vasoconstrictor, can be elevated.[915,916]
A vasculopathy involving large arteries including the aorta and its branches has also been
described in young adults with AIDS. The features of this vasculopathy overlap with Takayasu’s
disease. With large artery vasculopathy there is a propensity for the appearance of single or
multiple aneurysms. The appearance of these lesions appears due to leukocytoclastic vasculitis
of vasa vasorum or small adventitial arteries. Medial fibrosis and vascular occlusion can occur.
There can be angiogenesis with proliferation of slit-like channels in the adventitia. There does
not seem to be an association of this vasculopathy with either atherosclerosis or with
opportunistic infections.[917]
MISCELLANEOUS FINDINGS.-- Hemorrhagic pericarditis is uncommon and
development of constrictive pericarditis unlikely.[896] Rheumatic inflammatory changes,
ranging from rare scattered Anitschkow myocytes to well-formed Aschoff nodules similar to
those seen in rheumatic heart disease, are rarely reported to occur in AIDS. However, chronic
rheumatic sequelae of fibrosis or valvular disease have not been seen in AIDS.[918]
