Austrian syndrome followed by severe cutaneous adverse reactions in a HIV patient

Invasive pneumococcal infection, defined as the combination of pneumonia with endocarditis and meningitis, was described as Austrian syndrome in the 1800s. We report the case of a 63-year-old woman with underlying human immunodeficiency virus who presented with fever and altered mental status. Subsequent workup supported a diagnosis of Austrian syndrome. During the 5-week course of ceftriaxone treatment, she developed fever, pruritus and follicular accentuation throughout the body. Labs were significant for eosinophilia, which along with systemic symptoms, supported the diagnosis of a drug reaction. Coagulase negative staphylococcus bacteremia was discovered when the patient developed septic shock. Subsequently, diffuse desquamative eruption with rapidly progressing sloughing appeared and biopsy proved toxic epidermal necrolysis. Patient eventually succumbed to multiorgan failure.