Austrian Syndrome Caused by Highly Penicillin-Resistant Streptococcus pneumoniae

Abstract

The finding of pneumococcal meningitis and pneumonia in an alcoholic patient requires that the diagnosis of endocarditis be excluded. This tetrad was first described by Osler but is also known as the Austrian syndrome. Nowadays, this entity is uncommon, since the incidence of Streptococcus pneumoniae endocarditis has significantly decreased (from 10%–15% of endocarditis cases in the preantibiotic era to 1%–3% now). Penicillin-resistant strains of S. pneumoniae account for 44%– 58% of cases in some European countries and for 24% in the United States [1], and are a matter of concern worldwide. Herein we report what we believe is the first case of an alcoholic patient with infective endocarditis, meningitis, and pneumonia caused by S. pneumoniae resistant to penicillin and cefotaxime.