Rupture of aortic aneurysm in MASS syndrome

A case of aortic rupture in a patient with MASS syndrome (Marfanoid Autism Spectrum Syndrome) after re-infection with Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2) is presented. Objective. To assess the condition of the aorta of a female patient with MASS syndrome and a history of COVID-19. Materials and methods. The clinical data, autopsy, and histological results were reviewed and described. Results. The patient’s first COVID-19 infection occurred in April 2025. COVID-19 re-infection was reported in September 2025. The first clinical signs appeared about two weeks before hospitalization. In outpatient settings, she took antipyretics, and her condition improved. Two weeks after the onset of the described symptoms, she reported severe chest pain. She had a history of MASS syndrome. Visceral organs were unremarkable. Upon admission, the Beck triad, dyspnea, expansion of the percussion zone of the vascular bundle, and the systolic and diastolic murmur at the aorta projection area were found. Blood pressure was 86/50 mmHg. The level of thoracoabdominal cytoplasmic myocardial complex was increased up to 10 mg/L. PSI (Pneumonia Severity Index) score corresponded to risk IV (arterial blood pH <7.35, blood urea nitrogen >11 mmol/L). The patient died suddenly. In the ascending part of the thoracic aorta, a through defect of the wall up to 1 cm was found. Histological examination showed destruction of elastic fibers in the tunica media and degeneration of smooth muscles. Conclusion. It is likely that the new coronavirus infection should be considered an additional risk factor for aortic aneurysm rupture in individuals with MASS syndrome.