Austrian Syndrome - A Devastating Osler's Triad: Case Report and Literature Review.

Rastko Rakočević,Kathleen M Pergament,Sara Shapouran

doi:10.7759/cureus.4486

Rastko Rakočević, Kathleen M Pergament + Show 1 more

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https://doi.org/10.7759/cureus.4486

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Abstract

Austrian syndrome is a rare triad of meningitis, pneumonia, and endocarditis caused by Streptococcus pneumoniae. We present a case of the Austrian syndrome in the oldest patient in the reviewed literature, with no other classically described risk factors. She had an unusual initial presentation and microorganism portal of entry. Her hospital course was complicated by the diagnosis of monoclonal gammopathy, septic knee joint, septic brain emboli and respiratory failure. We also provide an extensive review of available literature of this commonly unrecognized entity.

Highlights

The rare triad of meningitis, pneumonia, and endocarditis caused by Streptococcus pneumoniae (S. pneumoniae) is known as Austrian syndrome (Osler’s triad) and is associated with high morbidity and mortality rates despite aggressive therapeutic management.Case PresentationA 76-year-old active and independent woman with a history of diabetes mellitus, hypertension and chronic cervical and lumbar degenerative disease presented to our hospital with a threeday history of headache and minimally altered mental state (AMS, rude and aggressive per family)
Austrian syndrome is a rare triad of meningitis, pneumonia, and endocarditis caused by Streptococcus pneumoniae
She was afebrile on presentation and initial laboratory and radiological workup was negative for urinary tract infection (UTI) or pneumonia, but did reveal white blood cell count (WBC) of 11.100/μl

Summary

Introduction

The rare triad of meningitis, pneumonia, and endocarditis caused by Streptococcus pneumoniae (S. pneumoniae) is known as Austrian syndrome (Osler’s triad) and is associated with high morbidity and mortality rates despite aggressive therapeutic management. A 76-year-old active and independent woman with a history of diabetes mellitus, hypertension and chronic cervical and lumbar degenerative disease presented to our hospital with a threeday history of headache and minimally altered mental state (AMS, rude and aggressive per family) She was afebrile on presentation and initial laboratory and radiological workup was negative for urinary tract infection (UTI) or pneumonia, but did reveal white blood cell count (WBC) of 11.100/μl. Ceftriaxone therapy was continued, and the patient’s mental status improved She was discharged on day 31 and completed a total of six weeks of ceftriaxone treatment. One month later, she was admitted for AMS and UTI, treated with antibiotics with mental status improvement. The patient was discharged to home hospice where she eventually died

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