2025 Volume 32 Article ID: 32_R56
A 66-year-old male patient was transferred to our hospital with a chief complaint of impaired mobility. Upon admission, he was diagnosed with accidental hypothermia. After 12 hours, he developed shock and was admitted to the intensive care unit. On day 2 of hospitalization, a rapid and massive accumulation of pleural fluid was observed in the left thoracic cavity. The analysis of the pleural fluid revealed empyema thoracis. Chest drainage and lavage were performed. Candida glabrata (Nakaseomyces glabrata) was identified in the pleural fluid culture, and the patient was diagnosed with fungal empyema. The patient had no history of surgery or symptoms suggestive of gastrointestinal disease. CT revealed no esophageal wall abnormalities or mediastinal emphysema. However, gastrointestinal perforation could not be completely ruled out as a route of fungal invasion. Therefore, upper gastrointestinal endoscopy was performed, which revealed extensive erythema and white plaque adhesion in the lower esophagus. A gastrointestinal contrast study demonstrated leakage of contrast material from the esophagus. The patient underwent thoracotomy and prolonged intrathoracic lavage, and both the esophageal perforation and empyema were successfully treated. Clinicians should investigate the possibility of esophageal perforation in cases of fungal empyema, even in the absence of gastrointestinal symptoms or surgical or hospitalization history.
