# Multisite infection with Austrian syndrome caused by non-vaccine pneumococcal serotype—case report

## TL;DR

A rare and severe case of Austrian syndrome caused by a non-vaccine pneumococcal serotype is reported in an immunocompromised patient.

## Contribution

The report highlights a rare multisite infection caused by a non-vaccine pneumococcal serotype in an immunocompromised individual.

## Key findings

- Austrian syndrome was complicated by spondylodiscitis and endophthalmitis in an immunocompromised patient.
- The causative serotype (23B) is not included in standard pneumococcal vaccines.
- Reduced susceptibility to benzylpenicillin was observed, which is uncommon in Denmark.

## Abstract

Although rare, Austrian syndrome remains a life-threatening triad consisting of pneumonia, endocarditis, and meningitis caused by Streptococcus pneumoniae.

We present a case of Austrian syndrome, further complicated by spondylodiscitis and endophthalmitis, in an immunocompromised male receiving methotrexate treatment for rheumatoid arthritis. The infection was caused by a non-vaccine pneumococcal serotype (23B). Susceptibility testing showed reduced susceptibility towards benzylpenicillin, an uncommon finding in Denmark.

This case illustrates some of the challenges faced in managing invasive pneumococcal disease and underlines the importance of continued awareness of this disease, particularly in immunocompromised patients.