The triad of pneumonia, meningitis, and endocarditis due to Streptococcus 
pneumoniae is known as Austrian syndrome. We report a case with an aortic-right 
atrium fistula in a 39-year-old woman who had undergone splenectomy for 
Hodgkin's lymphoma. The review of literature shows that the prevalence of 
Austrian syndrome is decreasing from 19% to 3% of patients with pneumococcal 
endocarditis in recent years. This case emphasizes that diagnosis of 
endocarditis should be considered early in every patient with pneumococcal 
meningitis or bacteremia, particularly in immunocompromised patients.