# Surviving the Deadly Triad: Two Cases of Austrian Syndrome in Southern Switzerland, Associated With Disseminated Streptococcus pneumoniae Infection

## TL;DR

This paper presents two rare cases of Austrian syndrome in Switzerland, highlighting the severe complications of Streptococcus pneumoniae infections and the need for combined medical and surgical treatment.

## Contribution

The paper contributes two detailed clinical cases of Austrian syndrome with disseminated S. pneumoniae infection, emphasizing the importance of early diagnosis and vaccination.

## Key findings

- Austrian syndrome was diagnosed in two patients with severe complications including meningitis, endocarditis, and septic arthritis.
- Both patients had S. pneumoniae isolated from multiple sites and required intensive treatment with antibiotics and surgery.
- The cases underscore the importance of vaccination to prevent invasive pneumococcal disease.

## Abstract

Austrian syndrome is a rare and life-threatening condition. It is more severe in immunocompromised patients, those with comorbidities, or harmful alcohol consumption. The etiopathogenesis involves hematogenous seeding of Streptococcus pneumoniae and local spread in the infected tissues, presenting with pneumonia, endocarditis, and meningitis. A 68-year-old man was hospitalized for impaired consciousness, left hemiparesis, and aphasia, consistent with meningoencephalitis. A CT scan showed otomastoiditis and bilateral pulmonary consolidations with respiratory failure. A transesophageal echocardiogram revealed endocardial vegetations at the mitral-aortic junction and left ventricular outflow tract, requiring aortic valve replacement. He also developed septic arthritis in both prosthetic hips and bilateral muscular abscesses. The second patient is a 50-year-old man who was hospitalized for lumbar back pain, aphasia, left-sided neglect, and a motor deficit in the right lower limb. A CT scan showed spondylodiscitis at the L5-S1 level, an abscess in the right frontal region (both confirmed on MRI), and bilateral pulmonary consolidations. A transesophageal echocardiogram revealed endocardial vegetation on the aortic valve. In both patients, S. pneumoniae susceptible to penicillin was isolated from all septic sites. After the initial treatment with empirical broad-spectrum antibiotics, therapy was switched to intravenous ceftriaxone and then oral amoxicillin. From these cases, it appears that Austrian syndrome usually requires an intensive approach, combining both medical and surgical interventions to guarantee a positive outcome. It is mandatory to identify individuals at risk to promote the role of vaccination in preventing the development of Austrian syndrome and, more generally, invasive pneumococcal disease.