{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T08:08:04Z","timestamp":1753862884687,"version":"3.41.2"},"reference-count":13,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,7,2]],"date-time":"2023-07-02T00:00:00Z","timestamp":1688256000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec><jats:title>Key Clinical Message<\/jats:title><jats:p>Austrian Syndrome classically consists of meningitis, endocarditis, and pneumonia due to <jats:italic>Streptococcus pneumonia<\/jats:italic> bacteremia. A literature review, however, does not show variants of this triad. Our case highlights a unique variant of Austrian Syndrome with mastoiditis, meningitis, and endocarditis which requires immediate recognition and treatment to prevent devastating patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p><jats:italic>Streptococcus pneumonia<\/jats:italic> is responsible for more than 50% of all bacterial meningitis and has a case fatality rate of 22% in adults. In addition, <jats:italic>Streptococcus pneumonia<\/jats:italic> is also one of the most common causes of acute otitis media, a known cause of mastoiditis. However, in conjunction with bacteremia and endocarditis, limited evidence is able to be identified. This sequence of infections also closely relates to Austrian syndrome. Otherwise known as Osler's triad, Austrian syndrome is a rare phenomenon of meningitis, endocarditis, and pneumonia secondary to <jats:italic>Streptococcus pneumonia<\/jats:italic> bacteremia that was first delineated by Robert Austrian in 1956. The incidence of Austrian syndrome is reported to be less than &lt;0.0001% per year and has decreased significantly since the initial usage of penicillin in 1941. Despite this, the mortality rate of Austrian syndrome is still around 32%. Despite an extensive literature review, we were unable to find any reported cases of variants of Austrian syndrome that include mastoiditis as the primary insult. As such, we present a unique presentation of Austrian syndrome with mastoiditis, endocarditis, and meningitis with complex medical management that led to resolution for the patient. To discuss the presentation, progression, and complex medical management of a previously undiscussed triad of mastoiditis, meningitis, and endocarditis occurring in a patient.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccr3.7648","type":"journal-article","created":{"date-parts":[[2023,7,3]],"date-time":"2023-07-03T03:54:54Z","timestamp":1688356494000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Meningitis and endocarditis as a sequela of streptococcus pneumonia mastoiditis: A case report"],"prefix":"10.1002","volume":"11","author":[{"given":"Mitchell","family":"Peebles","sequence":"first","affiliation":[{"name":"PGY\u20102 Internal Medicine Resident at Texas Health Harris Methodist Hospital  Fort Worth Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehnaz","family":"Roshani","sequence":"additional","affiliation":[{"name":"Internal Medicine Core Faculty at Texas Health Harris Methodist Hospital  Fort Worth Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2502-7480","authenticated-orcid":false,"given":"Kumaraman","family":"Srivastava","sequence":"additional","affiliation":[{"name":"MS4 at Anne Burnett Marion School of Medicine at Texas Christian University  Fort Worth Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,7,2]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Clinical features of pneumococcal disease.Centers for Disease Control and Prevention. January 27 2022. Accessed May 10 2023.https:\/\/www.cdc.gov\/pneumococcal\/clinicians\/clinical\u2010features.html."},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","unstructured":"ShinYI PapyanN Cede\u00f1oH StratidisJ.Austrian syndrome: the deadly triad. doi:10.1016\/j.idcr.2020.e00948IDCases. 2020;22:e00948. Epub 2020 Sep 4. 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