Severe Austrian Syndrome in an Immunocompromised Adult Patient – A Case Report

Ioana Raluca Chirteș¹, Dragos Florea², Carmen Chiriac^1,3, Oana Maria Mărginean¹, Cristina Mănășturean³, Alexander A Vitin⁴, Anca Meda Georgescu^1,3

1 University of Medicine and Pharmacy of Tirgu Mures, Romania
2 National Institute of Infectious Diseases ”Prof. Dr Matei Bals”, Laboratory of Molecular Biology, Bucharest, Romania
3 Mures County Hospital, Infectious Diseases Clinic I, Tirgu Mures, Romania
4 Department of Anesthesiology & Pain, Medicine University of Washington Medical Center, Seattle WA, USA

DOI: 10.1515/jccm-2017-0025

Background: Known also as Osler’s triad, Austrian syndrome is a complex pathology which consists of pneumonia, meningitis and endocarditis, all caused by the haematogenous dissemination of Streptococcus pneumoniae. The multivalvular lesions are responsible for a severe and potential lethal outcome.
Case report: The case of a 51-year-old female patient, with a past medical history of splenectomy, is presented. She developed bronchopneumonia, acute meningitis and infective endocarditis as a result of Streptococcus pneumoniae infection and subsequently developed multiple organ dysfunction syndromes which led to a fatal outcome. Bacteriological tests did not reveal the etiological agent. The histopathological examination showed a severe multivalvular endocarditis, while a PCR based molecular analysis from formalin fixed valvular tissue identified Streptococcus pneumoniae as the etiologic agent.
Conclusions: The presented case shows a rare syndrome with a high risk of morbidity and mortality. Following the broad-spectrum treatment and intensive therapeutic support, the patient made unfavourable progress which raised differential diagnosis problems. In this case, the post-mortem diagnosis demonstrated multiple valvular lesions occurred as a result of endocarditis.