BACKGROUND: Known also as Osler's triad, Austrian syndrome is a complex 
pathology which consists of pneumonia, meningitis and endocarditis, all caused 
by the haematogenous dissemination of Streptococcus pneumoniae. The 
multivalvular lesions are responsible for a severe and potential lethal outcome.
CASE REPORT: The case of a 51-year-old female patient, with a past medical 
history of splenectomy, is presented. She developed bronchopneumonia, acute 
meningitis and infective endocarditis as a result of Streptococcus pneumoniae 
infection and subsequently developed multiple organ dysfunction syndromes which 
led to a fatal outcome. Bacteriological tests did not reveal the etiological 
agent. The histopathological examination showed a severe multivalvular 
endocarditis, while a PCR based molecular analysis from formalin fixed valvular 
tissue identified Streptococcus pneumoniae as the etiologic agent.
CONCLUSIONS: The presented case shows a rare syndrome with a high risk of 
morbidity and mortality. Following the broad-spectrum treatment and intensive 
therapeutic support, the patient made unfavourable progress which raised 
differential diagnosis problems. In this case, the post-mortem diagnosis 
demonstrated multiple valvular lesions occurred as a result of endocarditis.