title: Emergent double valve replacement in Austrian syndrome.
abstract: Bi-valvular pneumococcal endocarditis in Austrian syndrome, which includes a triad of pneumococcal endocarditis, pneumonia, and meningitis, is a rare but life-threatening disease. We present a case of a woman found to have Austrian syndrome who presented to the emergency department (ED) with dehydration and radiographical signs of lobar pneumonia and quickly deteriorated to fulminant cardiogenic shock in less than four hours. An early echocardiogram in the ED confirmed a diagnosis of bi-valvular endocarditis with severe aortic and mitral valve insufficiency and large vegetations on the valve leaflets requiring emergent surgical intervention with double valve replacement. Assumed meningitis as a part of the triad of Austrian syndrome was confirmed by imaging the day after hospital admission. Early diagnosis of endocarditis by obtaining the echocardiogram in the ED along with emergent surgical intervention allowed for a favorable outcome for the patient.
authors.affiliation: Department of Emergency Medicine, The George Washington University, Washington, DC. Electronic address: hshokoohi@mfa.gwu.edu.
authors.forename: Hamid
authors.initials: H
authors.lastname: Shokoohi
authors.affiliation: Department of Emergency Medicine, The George Washington University, Washington, DC.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Haywood
authors.affiliation: Department of Cardiovascular Thoracic Surgery, The George Washington University, Washington, DC.
authors.forename: Farzad
authors.initials: F
authors.lastname: Najam
authors.affiliation: Department of Radiology, The George Washington University, Washington, DC.
authors.forename: M Reza
authors.initials: MR
authors.lastname: Taheri
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000150:complications* / Q000601:surgery; D004452:Echocardiography; D004636:Emergency Service, Hospital; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008586:Meningitis, Pneumococcal / Q000150:complications / Q000175:diagnosis; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000601:surgery; D011008:Pneumococcal Infections / Q000150:complications / Q000175:diagnosis*; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000175:diagnosis; D013577:Syndrome