The clinical triad of pneumococcal pneumonia, meningitis, and endocarditis known as Austrian syndrome is associated with a high mortality rate despite appropriate antibiotic usage, unless surgically managed when indicated. The most common risk factor for Austrian syndrome is alcoholism. We present a case of Austrian syndrome in an intravenous drug user (IVDU) where none of the previously described risk factors for the syndrome were present. There has been only 1 other report of Austrian syndrome in an IVDU. A high index of suspicion for this syndrome may be warranted in IVDUs who also present with both pneumococcal pneumonia and meningitis. Echocardiography early in the disease course may identify concurrent endocarditis and indications for surgical intervention with resultant decrease in mortality associated with the syndrome.