Mitral valve replacement for isolated mitral valve endocarditis: A survival case of Austrian syndrome

Austrian syndrome, characterized by the triad of pneumonia, meningitis, and endocarditis due to Streptococcus pneumoniae, is a rare but life-threatening entity. It typically involves the aortic valve, while isolated mitral valve involvement is exceedingly uncommon. We describe a 59-year-old male with type 1 diabetes mellitus and a dual-chamber pacemaker who presented with nausea, vomiting, fever, chills, and altered mentationproductive coug. Laboratory and cerebrospinal fluid analyses confirmed pneumococcal meningitis and bacteremia. Echocardiography revealed large vegetations with severe mitral regurgitation, valvular perforation, and abscess formation, consistent with Austrian syndrome involving the mitral valve only. The patient underwent urgent bioprosthetic mitral valve replacement followed by pacemaker removal and biventricular device implantation. Post-operatively, he completed a four-week course of intravenous ceftriaxone with complete recovery. This case highlights an unusual presentation of Austrian syndrome with isolated mitral valve destruction rather than the typical aortic involvement. Early surgical intervention combined with prompt microbiological diagnosis and targeted antibiotic therapy were crucial for a favorable outcome. Clinicians should maintain a high index of suspicion for Austrian syndrome in patients presenting with meningitis and pneumonia, even when echocardiographic findings suggest isolated mitral valve disease. Early diagnosis and timely surgical management can be lifesaving.