Multiple Arterial Aneurysms Probably of Tuberculous Origin in HIV–Tuberculosis Coinfection: A Fatal Case Report

Tuberculous arterial aneurysms are a rare but severe complication of tuberculosis. We report the case of a 37-year-old woman with no known medical history who was admitted with deterioration of her general condition. Laboratory investigations revealed severe anaemia with a haemoglobin level of 6.6 g/dL, leukopenia with lymphopenia, markedly elevated lactate dehydrogenase levels, and impaired renal function. Cervicothoracoabdominopelvic computed tomography angiography demonstrated multiple aneurysmal lesions involving the right common carotid artery, the descending thoracic aorta, and the abdominal aorta, associated with multiple necrotic thoracoabdominal lymph nodes. Infectious work-up revealed HIV infection with a high viral load and active tuberculosis, documented by positive acid-fast bacilli testing and GeneXpert MTB/RIF. Antituberculous and antiretroviral therapies were initiated, together with transfusion of three units of packed red blood cells. The initial strategy for the aneurysms was to achieve preliminary control of the infectious process before definitive vascular treatment. The following day, however, the patient developed severe shock, probably haemorrhagic, strongly suggesting aneurysmal rupture. The clinical course was rapidly fatal. This case highlights the severity of multiple infected aneurysms and the difficulty of determining the optimal timing of vascular repair.