2017 Volume 33 Issue 4 Pages 550-554
A 60–year–old man was admitted to our hospital with a diagnosis of pneumococcal meningitis. Even though his meningitis had become less severe with antibiotic administration, the results of echocardiography indicated severe aortic regurgitation and prolapse. The progress of his recovery was considered good, but on the 13th day of his hospitalization, he experienced a relapse with worsening of inflammatory findings. Subsequently, his respiratory condition deteriorated and his symptoms rapidly progressed in a manner consistent with heart failure. We diagnosed his condition as valvular damage and acute heart failure caused by infectious endocarditis. Aortic valve replacement and aortic root angioplasty were performed on the 22nd day of hospitalization, and he was discharged from the hospital on 57th day of hospitalization.
Despite receiving appropriate treatment, pneumococcal pneumonia and meningitis are sometimes complicated by infectious endocarditis. Classically, the association of pneumococcal meningitis, pneumonia and infectious endocarditis is known as Austrian syndrome. It is thought that heavy users of alcohol and hosts with compromised immunity tend to be at risk for this syndrome, but this patient had no such risk factors. In patients with pneumococcal infection, even those with no risk factors, if symptoms worsen it is necessary to keep this triad in mind and conduct physical examination carefully such as auscultation of heart murmur as for a thorough evaluation.
