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

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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.

1. Baig A, Moskovits M, Errold EM, et al. Austrian syndrome and multiple myeloma: a fatal combination. North Am J Med Sci. 2012;4:516-9.

2. Aronim SI, Mukherjee SK, West JC, et al. Review of pneumococcal endocarditis in adults in the penicillin era. Clin Infect Dis. 1998;26:165-71.

3. Bruyn GA, Thompson J, Van der Meer JW. Pneumococcal endocarditis in adult patients. A report of five cases and review of the literature. Q J Med. 1990;74:33-40.

4. Midon ME, Goldoni F, Souza SG, Miyasato JN. Austrian syndrome. Arq Bras Cardiol. 2011;97:e50-2.

5. Lindberg J, Prag J, Schonheyder HC. Pneumococcal endocarditis is not just a disease of the past: an analysis of 16 cases diagnosed in Denmark 1986-1997. Scand J Infect Dis. 1998;30:469-72.

6. De Egea V, Munoz P, Valerio M, et al. Characteristics and outcome of Streptococcus pneumoniae endocarditis in the XXI Century. A systematic review of 111 cases (2000-2013). Medicine (Baltimore). 2015;94:e1562.

7. Belvisi V, del Borgo C, Morelli F, et al. Late onset invasive pneumococcal disease in a liver transplanted patien: beyond the Austrian syndrome. Transpl Infect Dis. 2013;15:E111-4.

8. Pesola GR, Charles A. Pneumococcal bacteraemia with pneumonia. Mortality in acquired immunodeficiency syndrome. Chest. 1992;101:150-5.

9. Munoz P, Sainz J, Rodriguez-Crexems M, et al. Austrian Syndrome caused by highly penicillin-resistant Streptococcus pneumoniae. Clin Infect Dis. 1999;29:1591-2.

10. Siegel M, Timpone J. Penicillin-resistant Streptococcus pneumoniae endocarditis: a case report and review. Clin Infect Dis. 2001;32:972-4.

11. Finland M, Barnes M. Changing etiology of bacterial endocarditis in the antibacterial era. Experiences at Boston city Hospital 1933-1965. Ann Intern Med. 1970;72:341-8.

12. Bonow R, Carabello B, Kanu C, et al. ACC/AHA 2006 guidelines for the management of patients with valvular hearth disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for The Management of the Patients with Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anaesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006;114:e84-231.

13. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guidelines for the Management of Patients with Valvular Heart Disease. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017. doi: 10.1016/j.jacc.2017.03.011.

14. Bouza E, Pintado V, Rivera S, et al. Nosocomial bloodstream infections caused by Streptococcus pneumoniae. Clin Microbiol Infect. 2005;11:919-24.

15. Georgescu AM, Azamfirei L, Szalman K et al. Fatal endocarditis with methicilin-sensible Staphylococcus aureus and major complications: rhabdomyolysis, pericarditis, and intracerebral haematoma. A case report and review of the literature. Medicine (Baltimore). 2016;94:e5125.

16. Haranahalli PE, Yadov S, Shukla M, et al. A rare case of quadruple valve infective endocarditis of normal vative valves-the advantage of TEE. Turk Kardiol Dern Ars. 2013;41:732-5.

17. Zea-Vera R, Sanchez M, Castaneda E. Surgical management of multiple valve endocarditis associated with dialysis catheter. Case Rep Infect Dis. 2016. doi: 10.1155/2016/4072056.

18. Pana M, Ghita M, Nica M, et al. Study of Streptococcus pneumoniae strains resistant to antibiotics analysed at “Cantacuzino” MIRDMI during 2006-2008. Bacteriol Virusol Parazitol Epidemiol. 2010;55:95-102.

19. Bancescu G, Neagu AS, Radu-Popescu M, et al. Susceptibility testing of Streptococcus pneumoniae and Viridans Streptoccocal isolates against: quinolones, oxazolidinones and glycopeptides. Rev Med Chir Soc Med Nat Iasi. 2012;116:286-90.

20. Moore MR, Link-Gelles R, Schaffner W, et al. Impact of 13-valent Pneumococcal Conjugate Vaccine used in children and adults in the United States; analysis of multisite, population-based surveillance. Lancet Infect Dis. 2015;15:301-9.

21. Alari A, Chaussade H, Domenech de Celles M, et al. Impact of pneumococcal conjugate vaccines on pneumococcal meningitis cases in France between 2001 and 2014: a time series analysis. BMC Med. 2016;14:211.

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