BACKGROUND: Austrian syndrome, which is also known as Osler's triad, is a rare 
aggressive pathology consisting of pneumonia, endocarditis, and meningitis 
caused by Streptococcus pneumoniae and carries drastic complications.
CASE PRESENTATION: A case of a 68-year-old female with a past medical history of 
hypertension and had a recent viral influenza is presented. She developed 
bacterial pneumonia, endocarditis with mitral and aortic vegetations and 
perforation, meningitis, and right sternoclavicular septic arthritis. Two prior 
case reports have described sternoclavicular septic arthritis as part of 
Austrian syndrome. Our case is the third case; however, it is the first case to 
have this tetrad in an immunocompetent patient with no risk factors, i.e., 
males, chronic alcoholism, immunosuppression, and splenectomy.
CONCLUSIONS: Clinicians should maintain a high index of suspicion for the 
possibility of sternoclavicular joint septic arthritis as a complication of 
Austrian syndrome in immunocompetent patients.