© 2003 BMJ Publishing Group Ltd & Association of Clinical Pathologists
CASE REPORT
Corticosteroids as adjunctive treatment in Austrian’s syndrome (pneumococcal endocarditis, meningitis, and pneumonia): report of two cases and review of the literature
1 Department of Medical Intensive Care, University Hospital of Caen, 14000 Caen, France
2 Department of Thoracic and Cardiovascular Surgery, University Hospital of Caen
3 Department of Anaesthesiology, University Hospital of Caen
4 Department of Microbiology, University Hospital of Caen
Correspondence to:
Correspondence to:
Dr D du Cheyron
Department of Medical Intensive Care, CHU de Caen, Av Cote de Nacre, 14000 Caen, France; ducheyron-d{at}chu-caen.fr
This report describes two cases of Osler’s triad of pneumonia, meningitis, and endocarditis, as a result of Streptococcus pneumoniae infection, also called Austrian’s syndrome. In the first patient, a 51 year old non-alcoholic man, the aortic valve was affected and needed to be replaced in an emergency operation. The mitral valve was affected in a 70 year old woman without underlying disease, who only benefited from medical treatment. Both patients received corticosteroids, either dexamethasone followed by low doses of hydrocortisone and fludrocortisone, or only hydrocortisone and fludrocortisone, at the onset of the illness, and their outcome was favourable. These case reports focus on the presentation, prognosis, and therapeutic options for this severe syndrome.
Keywords: streptococcus pneumoniae; endocarditis; meningitis; corticosteroids
Abbreviations: AV, atrioventricular; CT, computed tomography; CSF, cerebrospinal fluid; ICU, intensive care unit; MIC, minimum inhibitory concentration
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