Thunstedt Cem, Palleis Carla, Wischmann Johannes, Heck Suzette, Dimitriadis Konstantinos, Klein Matthias
Department of Neurology, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
Emergency Department, LMU University Hospital, LMU Munich, Munich, Germany.
BMC Neurol. 2025 Jan 22;25(1):32. doi: 10.1186/s12883-025-04033-7.
Purulent meningitis poses a significant clinical challenge with high mortality. We present the case of a 54-year-old female transferred to our emergency department with suspected bacterial meningitis, later diagnosed as an Austrian syndrome.
The patient exhibited subacute somnolence, severe headache, nausea and fever. Initial antibiotic therapy was initiated without successful lumbar puncture. Upon arrival at our hospital, she presented with septic shock, meningism, and respiratory symptoms. Lumbar puncture revealed cloudy cerebrospinal fluid with elevated cell count, protein, and low glucose. While blood and CSF cultures remained negative, multiplex PCR for Streptococcus pneumoniae was positive even 10 h after beginning of effective antibiotic therapy. Subsequent echocardiogram revealed mitral valve endocarditis and the patient underwent valve replacement.
Altogether, bacterial meningitis presents with cardinal clinical signs only half of cases. Lumbar puncture remains crucial, and our patient's CSF findings aligned with bacterial meningitis. Multiplex PCR aided in diagnosis, even after antibiotic treatment. The case highlights the importance of prompt lumbar puncture despite antibiotic pre-treatment. The patient's Austrian syndrome, characterized by meningitis, endocarditis, and pneumonia, emphasizes the need for vigilance regarding skin lesions, early cerebral infarctions, and iritis. This case emphasizes the complexity of bacterial meningitis diagnosis and the utility of multiplex PCR, especially in prolonged antibiotic-treated patients. However, PCR cannot replace cultures when it comes to adapting therapy based on the antibiotic sensitivity of the causative pathogen. Awareness of Austrian syndrome's diverse manifestations is crucial for timely recognition and appropriate management.
化脓性脑膜炎是一项重大的临床挑战，死亡率很高。我们报告一例54岁女性，因疑似细菌性脑膜炎被转诊至我院急诊科，后来被诊断为奥地利综合征。
患者表现为亚急性嗜睡、严重头痛、恶心和发热。在未成功进行腰椎穿刺的情况下开始了初始抗生素治疗。到达我院时，她出现了感染性休克、脑膜刺激征和呼吸道症状。腰椎穿刺显示脑脊液混浊，细胞计数、蛋白质升高，葡萄糖降低。虽然血液和脑脊液培养均为阴性，但即使在开始有效抗生素治疗10小时后，肺炎链球菌多重PCR检测仍为阳性。随后的超声心动图显示二尖瓣心内膜炎，患者接受了瓣膜置换术。
总体而言，细菌性脑膜炎仅有半数病例呈现典型临床体征。腰椎穿刺仍然至关重要，我们患者的脑脊液检查结果与细菌性脑膜炎相符。即使在抗生素治疗后，多重PCR也有助于诊断。该病例强调了尽管进行了抗生素预处理，但仍需及时进行腰椎穿刺。患者的奥地利综合征以脑膜炎、心内膜炎和肺炎为特征，强调了对皮肤病变、早期脑梗死和虹膜炎保持警惕的必要性。该病例强调了细菌性脑膜炎诊断的复杂性以及多重PCR的实用性，尤其是在长期接受抗生素治疗的患者中。然而，在根据致病病原体的抗生素敏感性调整治疗方案时，PCR不能替代培养。认识到奥地利综合征的多种表现形式对于及时识别和适当管理至关重要。
