Austrian syndrome is a rare triad of meningitis, pneumonia, and endocarditis 
caused by Streptococcus pneumoniae. We present a case of the Austrian syndrome 
in the oldest patient in the reviewed literature, with no other classically 
described risk factors. She had an unusual initial presentation 
and microorganism portal of entry. Her hospital course was complicated by 
the diagnosis of monoclonal gammopathy, septic knee joint, septic brain 
emboli and respiratory failure. We also provide an extensive review of available 
literature of this commonly unrecognized entity.