Austrian syndrome in the context of a fulminant pneumococcal native valve endocarditis

Abstract

This is the case of a young male suffering from Austrian syndrome, which is the triad of endocarditis, meningitis, and pneumonia due to invasive S. pneumoniae infection. He reported recurrent fever for six months without any antibiotic treatment, which may have determined the further course of the syndrome. Echocardiography revealed massive native valve endocarditis, and the patient was considered for ultima-ratio cardiac surgery. Intraoperative aspect presented extensive affection of the aortic root with full destruction of aortic valve, mitral valve, and aortomitral continuity. The myocardium showed a phlegmon-like infiltration. Microbiologic testing of intraoperatively collected specimens identified penicillin-sensitive Streptococcus pneumoniae. S. pneumoniae is a very uncommon cause for infective infiltrative endocarditis and is associated with severe clinical courses. Austrian syndrome is even more rare, with only a few reported cases worldwide. In those patients, only early diagnosis, immediate antibiotic treatment, and emergent cardiac surgery can save lives.

A triad of endocarditis, endophthalmitis, and meningitis

“…It could also manifest as the Austrian syndrome -a triad of meningitis, endocarditis, and pneumonia [9]. In this case, meningitis was the primary presentation of infection, followed by a possible undetected bacteremia.…”

“…Together with intravenous antibiotic eye drops, solutions of tobramycin and dexamethasone were administered for the local treatment. At that stage of illness, laboratory findings revealed persistent leukocytosis -15 x10 9 /l, antistreptolysin O was of normal value, and CRP had been significantly reduced to 45 mg/L.…”

<i>Pasteurella multocida</i> Infective Endocarditis: A Possible Link with Primary Upper Respiratory Tract Infection

“…Such patients typically demonstrate a rapid and fulminant course, and if they survive, they may suffer limb amputations amongst other severe complications; early disease may produce seemingly innocuous minor hemorrhage (43), similar to this case. Moreover, both organisms may also rarely produce IE (44,45).…”

Infección invasiva por Streptococcus pneumoniae. Síndrome de Austrian: reporte de caso

“…Se le reconoce por la tríada de meningitis, neumonía y endocarditis por S. pneumoniae (2,6,7). La condición está asociada a una alta letalidad, particularmente en pacientes inmunosuprimidos (8,9); la destrucción valvular generada por la endocarditis es el principal factor pronóstico del síndrome, el cual cursa generalmente de forma agresiva, con focos sépticos metastásicos entre los que se han descrito los siguientes: meningitis (29-60 %), neumonía (35-60 %), artritis (2-14 %), compromiso ocular, aneurisma fúngico e infartos renal y esplénico (1). El foco infeccioso principal se presenta comúnmente sobre las válvulas nativas izquierdas, siendo la válvula aórtica la localización más frecuente de las vegetaciones.…”