Abstract 14942: Austrian Syndrome Complicated by Purulent Pericarditis

Abstract

Introduction: Austrian syndrome is a triad of pneumonia, endocarditis, and meningitis due to S. pneumoniae . First characterized by Robert Austrian in 1956, it is a rare condition with an unknown incidence since the advent of the antibiotic age and introduction of the pneumococcal vaccine. Case Presentation: A 69-year-old female with a history significant for alcohol abuse presented with shortness of breath, productive cough and encephalopathy. The patient was septic with concurrent NSTEMI. She was emergently intubated for hypoxia and CT chest revealed multifocal pneumonia with a pericardial effusion. Echocardiogram (TTE) demonstrated a mitral annular calcification extending into the ventricle and confirmed a small fibrinous effusion without tamponade physiology. Infectious workup revealed S. pneumoniae bacteremia and pneumonia and he was initiated on ceftriaxone. The patient remained encephalopathic despite antibiotic treatment. Lumbar puncture revealed S. pneumoniae meningitis. The patient’s mentation continued to decline. MRI brain revealed an embolic shower. Repeat echocardiogram showed worsening pericardial effusion and the patient suffered a cardiac arrest due to pericardial tamponade resolved with emergent pericardiocentesis. Pericardial fluid was noted to be serofibrinous with predominance of leukocytes albeit culture negative. Unfortunately the patient succumbed to her illness and passed. Conclusions: Males, alcoholics, the immunocompromised, or those with a history of heart valve surgery are at risk for Austrian Syndrome. Mortality is as high as 60%-75%. This patient was at risk due to her history of alcoholism. Her presentation is unique in that she had concurrent purulent pericarditis, which is rarely attributed to S. pneumoniae. The condition is fatal if untreated and mortality ranges from 15%-40%. Treatment entails prompt drainage and appropriate antibiotic coverage. The advent of pneumococcal vaccination has significantly reduced the incidence of S. pneumoniae infection. This case represents the widespread effects of this organism if left unrecognized and untreated. Clinicians should have a high index of suspicion in any patient with pneumococcal infection and underlying predisposing factors.