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• W4387249624 abstract "SESSION TITLE: Chest Infections Case Report Posters 36 SESSION TYPE: Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Osler's triad of meningitis, pneumonia and endocarditis secondary to S. pneumoniae is known as Austrian syndrome. While more frequent in the pre-antibiotic era, its incidence has since waned. However, the condition continues to be associated with severe morbidity and mortality. CASE PRESENTATION: A 69 year old male with no medical history presented for altered mentation and anorexia for 4 days. On admission, he was in severe sepsis with associated kidney injury, ischemic hepatitis, and encephalopathy. CT chest, abdomen and pelvis showed bilateral pleural effusions. CT head was unremarkable. Cefepime and vancomycin were initiated. Infectious workup showed positive S. pneumoniae urinary antigen (SPUAT). Bilateral thoracentesis revealed exudative effusions. Blood cultures demonstrated S. pneumoniae and echocardiogram demonstrated tricuspid vegetation. Antibiotics were narrowed to IV ceftriaxone and the patient continued to improve clinically with supportive therapy, however by day 4, he remained encephalopathic. Due to concern for central nervous system (CNS) involvement, antibiotic dosing was adjusted. MRI brain was negative for acute pathology. Lumbar puncture (LP) revealed glucose 20 mg/dL, protein >200 mg/dL, and WBC 68/uL suggesting CNS involvement. His mentation improved with treatment and he was discharged to rehab. DISCUSSION: Austrian syndrome has an estimated mortality of 60-75%. It is classically found in males, alcoholics, the immunocompromised, and those with prior heart valve surgery. While no data exists on the incidence of Austrian syndrome, S. pneumoniae remains the most common cause of bacterial pneumonia and bacterial meningitis worldwide. Invasive S. pneumoniae has an annual incidence of 24 per 100,000 in patient's aged ≧ 65 years. The use of the SPUAT allowed for rapid diagnosis and treatment of the patient's underlying condition. In the absence of traditional risk factors, we suspect our patient's endocarditis to have resulted from likely respiratory tract colonization. His onset of illness is unclear, but the presence of bilateral exudative effusions and tricuspid vegetation suggests prolonged infection prior to CNS invasion.Persisting encephalopathy in the setting of endocarditis prompted further investigations for possible CNS involvement. Additional work-up should assess for toxin, drug, or metabolic derangements as well as structural etiologies such as embolic stroke, brain abscess or mycotic aneurysms. However, suspected meningeal disease requires diagnostic LP. CONCLUSIONS: The SPUAT is a rapid and effective test to assist in the targeted therapy of S. pneumoniae infections. Austrian syndrome should be considered in patients with multi-system disease due to S. pneumoniae. Early assessment of CNS involvement with LP and MRI can mitigate morbidity and mortality. REFERENCE #1: Shin YI, Papyan N, Cedeño H, Stratidis J. Austrian syndrome: The deadly triad. IDCases. 2020;22. doi:10.1016/j.idcr.2020.e00948 REFERENCE #2: Pneumococcal disease surveillance reporting and trends. Centers for Disease Control and Prevention. https://www.cdc.gov/pneumococcal/surveillance.html#:~:text=Invasive%20pneumococcal%20disease%20caused%20by%20the%2013%20serotypes%20included%20in,per%20100%2C000%20people%20in%202019. Published September 1, 2020. Accessed March 28, 2023. REFERENCE #3: Factsheet about pneumococcal disease. European Centre for Disease Prevention and Control. https://www.ecdc.europa.eu/en/pneumococcal-disease/facts#:~:text=Invasive%20pneumococcal%20disease%20is%20defined,and%20invaded%20normally%20sterile%20sites. Published June 24, 2013. Accessed March 28, 2023. DISCLOSURES: No relevant relationships by Mashiul Chowdhury No relevant relationships by Rushi Patel No relevant relationships by Trinava Roy No relevant relationships by Rameez Shahid No relevant relationships by Rohan Umrani" @default.
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• W4387249624 date "2023-10-01" @default.
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• W4387249624 title "AUSTRIAN SYNDROME: A FORGOTTEN TRIAD" @default.
• W4387249624 doi "https://doi.org/10.1016/j.chest.2023.07.872" @default.
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