Introduction: Austrian syndrome is a rare triad of pneumonia, endocarditis, and meningitis caused by disseminated pneumococcus infection. This syndrome is a rare condition with a high mortality rate. Description: A 79-year-old woman with Alzheimer’s dementia and remote treated tuberculosis presented with acute confusion and weakness after a recent fall. She was febrile, hypotensive, tachypneic, and hypoxic on arrival. Labs revealed leukocytosis (24.2) and elevated lactate (3.3). Chest CT showed bilateral upper lobe consolidations, and she was started on sepsis protocol for presumed pneumonia. Her mental status rapidly declined in the ED, with gaze deviation prompting a stroke alert. While the initial head CT was negative, repeat imaging showed diffuse cerebral edema with signs of impending herniation. Empiric antimicrobials were started for suspected meningitis; lumbar puncture was deferred. She was intubated, started on vasopressors, and treated with hypertonic saline and dexamethasone. In the ICU, blood cultures grew Streptococcus pneumoniae. TTE revealed mitral valve vegetation and moderate regurgitation. After cerebral edema improved, LP showed elevated protein, lymphocytic pleocytosis, and normal glucose. Antibiotics were narrowed to ceftriaxone and vancomycin. Brain MRI revealed embolic infarcts. TEE was deferred due to reintubation risk. Though extubated by day 7, she remained encephalopathic and later developed acute hypercapnic respiratory failure. Unable to tolerate BiPAP, her condition worsened. After family discussions, care was transitioned to comfort measures, patient died. Discussion: Austrian syndrome is a rare, often fatal triad of pneumonia, meningitis, and endocarditis due to Streptococcus pneumoniae. Though its incidence has declined with antibiotics and vaccines, mortality remains high. Endocarditis typically affects the aortic valve, but our patient had mitral involvement. She lacked classic risk factors such as alcoholism or immunosuppression. Her course was complicated by cerebral edema, likely from meningitis and embolic infarcts. Despite early antibiotics, she deteriorated and died.
Ghimire et al. (Sun,) studied this question.