Summary

A usually fit and well 69-year-old woman presented with headache and altered consciousness. Initial clinical findings and investigations were consistent with a diagnosis of pneumococcal meningitis and pneumonia. Cultures of blood and cerebrospinal fluid grew Streptococcus pneumoniae. The patient continued to spike temperatures and developed cardiac failure. A transoesophageal echocardiogram demonstrated a large vegetation of the aortic valve causing severe aortic regurgitation. A diagnosis of Austrian syndrome, the triad of pneumococcal meningitis, pneumonia and endocarditis, was made. The patient has completed a course of appropriate antibiotic therapy and is awaiting aortic valve surgery.