Multisite infection with Austrian syndrome caused by non-vaccine pneumococcal serotype-case report.

Background: Although rare, Austrian syndrome remains a life-threatening triad consisting of pneumonia, endocarditis, and meningitis caused by Streptococcus pneumoniae. Case Summary: We present a case of Austrian syndrome, further complicated by spondylodiscitis and endophthalmitis, in an immunocompromised male receiving methotrexate treatment for rheumatoid arthritis. The infection was caused by a non-vaccine pneumococcal serotype (23B). Susceptibility testing showed reduced susceptibility towards benzylpenicillin, an uncommon finding in Denmark. Conclusion: This case illustrates some of the challenges faced in managing invasive pneumococcal disease and underlines the importance of continued awareness of this disease, particularly in immunocompromised patients.