[Austrian syndrome: a patient with meningitis, pneumonia and endocarditis]

Abstract

A 62-year-old man with a history of significant alcohol consumption presented with atypical neurological symptoms. Bacterial meningitis, caused by Streptococcus pneumoniae, was diagnosed with a 24-hour delay. Despite antibiotic treatment, the patient developed heart failure and multiple organ failure. He also had endocarditis with insufficient mitral and aortic valves. Subsequently, we found signs of a pulmonary infection. Because of an unsustainable haemodynamic situation, double heart valve replacement was considered necessary, despite the extremely high surgical risk and the extracardial infection foci showed by leukocyte scintigraphy. The patient died shortly after surgery. The triad of meningitis, pneumonia and endocarditis caused by Streptococcus pneumoniae is called the Austrian syndrome. This syndrome is rare and often has a serious course. It is strongly associated with asplenia, functional asplenia or hyposplenism, as occurs with alcohol abuse. Early recognition and a combination of antibiotic and surgical treatment is essential.