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• W2894591457 abstract "SESSION TITLE: Chest Infections 4 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Austrian syndrome is a combination of meningitis, pneumonia and endocarditis with invasive streptococcus pneumoniae infection, which is now rare in the era of modern antibiotics. Here we present a case of a woman who developed progressive symptoms characteristic of this syndrome. CASE PRESENTATION: A 74-year-old woman without significant comorbidities presented to her primary care physician after 3 days of cough and fever. A chest radiogram revealed patchy infiltrates and 7 days of oral levofloxacin was prescribed. Her symptoms did not improve and 2 days later, she was found confused with increased difficulty breathing. She was brought to the emergency department, where she had worsening infiltrates on chest radiograph. Due to significant increased work of breathing and hypotension, she was intubated and admitted MICU for management.In the MICU, she required norepinephrine for blood pressure support. She was treated for severe community acquired pneumonia with vancomycin, ceftriaxone and azithromycin. Her admission blood culture grew streptococcus pneumoniae and antibiotics were changed to vancomycin and ceftriaxone 2 gram every 12 hours for invasive streptococcus pneumoniae disease. Transesophageal echocardiogram showed small vegetation at the orifice of the mitral valve, consistent with endocarditis without indication for surgical intervention. Patient’s constellation of pneumonia, endocarditis, and presumed meningitis with history of altered mental status is consistent with Austrian syndrome. Unfortunately, she later developed complicated sacral ulcers requiring daily debridement, and family perused comfort care in the end. DISCUSSION: Among adults 65 years and older, the incidence of invasive pneumococcal illness has increased over the last decade. Robert Austrian initially reported 8 cases of pneumonia, endocarditis and meningitis in 1957. Patients with this syndrome typically present with pneumonia and/or meningitis. Endocarditis is often diagnosed later and can lead to acute heart failure. Aortic valve endocarditis is more common, but subtle vegetation on the mitral valve, as seen in this case, is described as well. Risk factors for invasive pneumococcal illness include alcoholism, splenectomy and immunodeficiency, which are not present in this case. Treatment includes high doses of ceftriaxone and vancomycin to ensure meningeal penetrance and early use of dexamethasone for pneumococcal meningitis. CONCLUSIONS: It is important to recognize Austrian syndrome in patients who present with pneumonia but continue to deteriorate despite appropriate antibiotic therapy. Early aggressive medical management with intravenous antibiotics can be life-saving. Prompt diagnosis of endocarditis is also essential, as patients can develop severe aortic regurgitation that requires surgical intervention. Reference #1: Austrian R. The syndrome of pneumococcal endocarditis, meningitis and rupture of the aortic valve. Trans Am Clin Climatol Assoc. 1956;68:40–7. discussion 48–50. Reference #2: De gans J, Van de beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347(20):1549-56. Reference #3: Phares CR, Lynfield R, Farley MM, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA. 2008;299(17):2056-65. DISCLOSURES: No relevant relationships by Paul Hampel, source=Admin input Advisory Committee Member relationship with GlaxoSmithKline Please note: $1001 - $5000 Added 03/02/2018 by Paul Scanlon, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Boehringer Ingelheim Please note: $1001 - $5000 Added 03/02/2018 by Paul Scanlon, source=Web Response, value=Consulting feed paid to employ Research Investigator relationship with GlaxoSmithKline Please note: >$100000 Added 03/02/2018 by Paul Scanlon, source=Web Response, value=Grant/Research Support Research Investigator relationship with Boehringer Ingelheim Please note: $20001 - $100000 Added 03/02/2018 by Paul Scanlon, source=Web Response, value=Grant/Research Support Reseaarch Investigator relationship with Astra Zeneca Please note: $20001 - $100000 Added 03/02/2018 by Paul Scanlon, source=Web Response, value=Grant/Research Support Research Investigator relationship with Forest Pharmceuticals Please note: $20001 - $100000 Added 03/02/2018 by Paul Scanlon, source=Web Response, value=Grant/Research Support Researhc Investigator relationship with Novartis Please note: $20001 - $100000 Added 03/02/2018 by Paul Scanlon, source=Web Response, value=Grant/Research Support No relevant relationships by Zhenmei Zhang, source=Web Response" @default.
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• W2894591457 date "2018-10-01" @default.
• W2894591457 modified "2023-09-25" @default.
• W2894591457 title "WHEN COMMUNITY ACQUIRED PNEUMONIA GOES BEYOND THE LUNGS" @default.
• W2894591457 doi "https://doi.org/10.1016/j.chest.2018.08.109" @default.
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