A 58-year-old male presented with a rare, severe Austrian syndrome, complicated by spondylodiscitis, caused by an uncommon non-vaccine serotype 23F of Streptococcus pneumoniae. The patient, with a history of alcohol abuse, end-stage kidney disease, and diabetes, developed pneumonia, infective endocarditis, and meningitis. Diagnosis was confirmed by blood and cerebrospinal fluid cultures, and echocardiography revealed aortic valve vegetations. The multisite infection highlights the aggressive nature of this pneumococcal serotype in vulnerable populations, requiring prolonged and tailored antibiotic therapy.
Key note: Austrian syndrome, especially with non-vaccine serotypes, can present with extensive multisite involvement and requires high clinical suspicion for timely diagnosis and management.