Abstract Details

Title Late-Onset Austrian Syndrome in a Patient with Bacterial Meningitis

Topic Infectious Disease

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-006

Objective

We report a unique case of Austrian Syndrome, with late onset pneumonia and endocarditis during the third week of antibiotic treatment for bacterial meningitis.

Background The triad of meningitis, pneumonia, and endocarditis caused by Streptococcus pneumoniae (S. Pneumoniae) is known as Austrian Syndrome (AS) and is associated with high morbidity and mortality.

Design/Methods NA

Results A 76-year-old woman with a history of chronic cervical and lumbar degenerative disease was admitted with a 3-day history of headache, altered mental status and fever of 103.2F. Vaccination records included Pneumococcal polysaccharide vaccine (PPSV 23) administered four years earlier. Kernig and Brudzinski signs were unreliable due to chronic neck and back pain. CT head showed no acute changes. Fluoroscopy guided lumbar puncture was unsuccessful. IV Ceftriaxone, Vancomycin, Ampicillin, Acyclovir and steroids were started for high suspicion of bacterial meningitis. Urine antigen and blood cultures showed S. Pneumoniae. On day 4, antibiotics were narrowed to Ceftriaxone, after results of sensitivity testing were received. On day 17, MRI Brain showed multiple sub-centimeter foci of restricted diffusion in the frontal and parietal lobes, consistent with septic emboli. Transthoracic echocardiogram revealed a new mobile mass on the ventricular surface of the aortic valve consistent with infectious endocarditis. Transesophageal echocardiogram could not be performed due to C1-C2 subluxation. On day 19, a new consolidation was visualized at the right lung base, consistent with pneumonia, confirming the diagnosis of AS. Ceftriaxone therapy was continued, and the patient’s mental status improved. She was discharged to rehabilitation on day 31 for continuation of antibiotics for a total of six weeks.

Conclusions AS is a rare manifestation of S. Pneumoniae infection. We describe a patient with late onset AS. Vigilant follow up of patients with S. Pneumoniae meningitis is warranted, irrespective of duration of antibiotic therapy or history of pneumococcal vaccination.

Authors/Disclosures
Sara Shapouran, MD (Montefiore) PRESENTER	Dr. Shapouran has nothing to disclose.
	No disclosure on file
	No disclosure on file
Machteld E. Hillen, MD, FAAN (Rutgers-NJMS)	The institution of Dr. Hillen has received research support from Genentech.

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