Austrian Syndrome Due to Corynebacterium Striatum in a Dialysis Patient With Multiple Comorbidities

Patients with multiple comorbidities, such as chronic kidney disease on hemodialysis (CKD-HD), diabetes mellitus (DM), and systemic arterial hypertension (SAH), are at higher risk for severe infections and systemic complications. We report a complex case of bacterial endocarditis due to Corynebacterium striatum in a CKD-HD patient, highlighting diagnostic and therapeutic challenges. A 57-year-old woman with CKD-HD, SAH, insulin-dependent type 2 DM, untreated hepatitis B, and peripheral arterial occlusive disease (PAOD) who had undergone right hallux amputation in May 2022 and subsequent stump infection treated with ciprofloxacin and clindamycin. She was admitted on 21/06/2022 with low back pain, fever, and neurological changes (aphasia and apathy). She presented with severe anemia (Hb 4.1 g/dL), hyponatremia, and elevated inflammatory markers. She developed extensive ischemic stroke and hemodynamic instability. CT scans revealed cavitary pulmonary nodules and hypodensity in the left middle cerebral artery territory. Blood cultures were positive for C. striatum (initially interpreted as contaminant), and urine culture grew KPC-producing Klebsiella pneumoniae (without urinary symptoms). Echocardiography confirmed aortic valve endocarditis with vegetations and severe regurgitation. The diagnosis of septic emboli to CNS and lungs was established on 29/06/22. Despite adjusted antibiotic therapy (vancomycin and gentamicin), neurological status deteriorated with Glasgow 6. Due to high bleeding risk and poor prognosis, surgery was contraindicated, and palliative care was chosen. She died on 07/07/2022. This case illustrates the complexity of endocarditis due to C. striatum, an opportunistic pathogen often underestimated. Penicillin resistance and difficulty distinguishing colonization from infection delayed appropriate treatment. The coexistence of CKD-HD, PAOD, and metabolic immunosuppression favored progression to sepsis and embolic complications. The inability to perform surgery due to stroke highlights the importance of early diagnosis and multidisciplinary management in high-risk patients. The fatal outcome reinforces the need for vigilance regarding infections by atypical organisms in vulnerable populations.