Peribáñez Sonia, De María-Mier Iván, Batin Diana, Martínez-Fleta Mario, Antonio-Martín Marta, Aured-Guallar Carmen, Vallejo-Gil José M, Vaca-Núñez Alexander S, Martínez-Álvarez Rosa M, Caballero-Asensio Ruth
Department of Cardiology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Department of Cardiac Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Egypt Heart J. 2025 Aug 12;77(1):79. doi: 10.1186/s43044-025-00676-6.
The Austrian syndrome is a rare but malignant triad consisting of pneumonia, meningitis, and endocarditis caused by an invasive pneumococcal infection, with a mortality rate of approximately 32%, rising to over 60% if not diagnosed early. Most of the knowledge about this rare disease comes from case reports. The uniqueness of this case lies in the late presentation of endocarditis.
A 59-year-old woman with a medical history of hypertension, dyslipidemia, hypothyroidism, and mesangial proliferative glomerulonephritis was admitted to our hospital with meningitis and pneumonia with bacteremia caused by Streptococcus pneumoniae. After receiving antibiotic treatment, the patient improved, and an echocardiogram was performed, ruling out endocarditis. She was discharged and readmitted three weeks later due to endocarditis with an acute perforation of the aortic valve, which required urgent surgery. Fortunately, the patient survived.
In cases of invasive pneumococcal disease with involvement of more than one focus, the possibility of developing infective endocarditis should be considered, especially in cases of hemodynamic instability or heart failure. The Austrian syndrome is a triad that should not be overlooked due to its high mortality rate, especially the possibility of the late onset of endocarditis.
奥地利综合征是一种罕见但严重的三联征，由侵袭性肺炎球菌感染引起，包括肺炎、脑膜炎和心内膜炎，死亡率约为32%，若未早期诊断，死亡率可升至60%以上。关于这种罕见疾病的大部分知识来自病例报告。本病例的独特之处在于心内膜炎出现较晚。
一名59岁女性，有高血压、血脂异常、甲状腺功能减退和系膜增生性肾小球肾炎病史，因肺炎链球菌引起的脑膜炎、肺炎伴菌血症入住我院。接受抗生素治疗后，患者病情好转，进行了超声心动图检查，排除了心内膜炎。患者出院，三周后因主动脉瓣急性穿孔的心内膜炎再次入院，需要紧急手术。幸运的是，患者存活下来。
在侵袭性肺炎球菌病累及多个病灶的情况下，应考虑发生感染性心内膜炎的可能性，尤其是在血流动力学不稳定或心力衰竭的情况下。奥地利综合征是一种不应因其高死亡率而被忽视的三联征，特别是心内膜炎可能出现较晚。
