A rare presentation of Austrian syndrome with septic arthritis in an immunocompetent female

Ayman Battisha,Omar Sheikh,Ahmed Altibi,Bader Madoukh

doi:10.1186/s43044-019-0010-6

Abstract

BackgroundAustrian syndrome, which is also known as Osler’s triad, is a rare aggressive pathology consisting of pneumonia, endocarditis, and meningitis caused by Streptococcus pneumoniae and carries drastic complications.Case presentationA case of a 68-year-old female with a past medical history of hypertension and had a recent viral influenza is presented. She developed bacterial pneumonia, endocarditis with mitral and aortic vegetations and perforation, meningitis, and right sternoclavicular septic arthritis. Two prior case reports have described sternoclavicular septic arthritis as part of Austrian syndrome. Our case is the third case; however, it is the first case to have this tetrad in an immunocompetent patient with no risk factors, i.e., males, chronic alcoholism, immunosuppression, and splenectomy.ConclusionsClinicians should maintain a high index of suspicion for the possibility of sternoclavicular joint septic arthritis as a complication of Austrian syndrome in immunocompetent patients.

Highlights

Austrian syndrome, which is known as Osler’s triad, is a rare aggressive pathology consisting of pneumonia, endocarditis, and meningitis caused by Streptococcus pneumoniae and carries drastic complications.Case presentation: A case of a 68-year-old female with a past medical history of hypertension and had a recent viral influenza is presented
Clinicians should maintain a high index of suspicion for the possibility of sternoclavicular joint septic arthritis as a complication of Austrian syndrome in immunocompetent patients
Streptococcus pneumoniae can rarely present in a triad of endocarditis, meningitis, and pneumonia, known as Osler’s triad, named after the Canadian Physician Sir William Osler who first described it in 1881

Summary

Background

Streptococcus pneumoniae, a gram-positive diplococcus, is the most common organism seen in patients with community-acquired pneumonia and hospital-acquired pneumonia as well as bacterial meningitis. In the ED, she was found to have a high-grade fever of 100.8 °F, tachycardia (pulse 115), tachypnea (respiratory rate 30/min), and normal blood pressure of 130/70 Further clinical assessment and workup revealed septic right sternoclavicular (SC) joint She was initially given vancomycin (20 mg/Kg IV q 8 h) and piperacillin-tazobactam (4.5 g IV q 6 h), which was subsequently narrowed to ceftriaxone (2 g IV q 12 h) following the culture and sensitivity results. She had a prolonged hospital course that required intravenous antibiotics, drainage of the right septic SC joint effusion, surgical mitral valve replacement, removal of the

Discussion

Availability of data and materials Yes

Conclusion