{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T05:00:54Z","timestamp":1764219654464,"version":"3.46.0"},"reference-count":12,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,11,7]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>\n                    Management of fungal empyema secondary to an oesophagopleural fistula remains challenging, especially when primary closure of the fistula is delayed. Prolonged infection causes malnutrition and, in rare cases, pleurocutaneous fistula (PCF) formation. We report the case of a woman in the mid-40s presenting with spontaneous oesophageal rupture complicated by right-sided empyema thoracis. Chest tube thoracostomy was performed, and pleural cultures yielded\n                    <jats:italic>Candida glabrata,<\/jats:italic>\n                    for which micafungin was initiated. Accidental removal of the chest tube resulted in purulent wound discharge, prompting re-admission and concern for PCF. A repeat CT demonstrated persistence of oesophagopleural fistula and empyema, while bronchoscopy excluded bronchopleural connections. Endoscopic clipping of the fistula was attempted but was unsuccessful. A multidisciplinary conference recommended video-assisted thoracostomy once the patient was optimised, while continuing long-term culture-guided antibiotics. Despite these interventions, she developed nosocomial pneumonia with respiratory failure. This case underscores the importance of early fistula closure, adequate pleural drainage and culture-guided antimicrobial therapy for optimal management.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2025-268656","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T03:45:20Z","timestamp":1764215120000},"page":"e268656","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pleurocutaneous fistula in a patient with non-\n                    <i>albicans Candida<\/i>\n                    empyema thoracis and spontaneous oesophagopleural fistula"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8212-0543","authenticated-orcid":false,"given":"Bryan Leonard Maniago","family":"Quizon","sequence":"first","affiliation":[{"name":"Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cary Amiel Gil","family":"Villanueva","sequence":"additional","affiliation":[{"name":"Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6941-9139","authenticated-orcid":false,"given":"Ralph Elvi","family":"Villalobos","sequence":"additional","affiliation":[{"name":"Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"2025112619451611000_18.11.e268656.1","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00542-2019","article-title":"The microbiology of pleural infection in adults: a systematic review","volume":"54","author":"Hassan","year":"2019","journal-title":"Eur Respir J"},{"key":"2025112619451611000_18.11.e268656.2","article-title":"Fungal empyema thoracis, a rare but an emerging entity: a retrospective case series from Pakistan","volume":"11","author":"Iqbal","year":"2024","journal-title":"Ther Adv Infect Dis"},{"key":"2025112619451611000_18.11.e268656.3","doi-asserted-by":"publisher","DOI":"10.1378\/chest.117.6.1672"},{"key":"2025112619451611000_18.11.e268656.4","first-page":"37","article-title":"A Case of Candida Empyema in a Patient With Esophagopleural Fistula","volume":"13","author":"Alyacoub","year":"2023","journal-title":"J Community Hosp Intern Med Perspect"},{"key":"2025112619451611000_18.11.e268656.5","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofaa656","article-title":"Candida Empyema Thoracis at Two Academic Medical Centers: New Insights Into Treatment and Outcomes","volume":"8","author":"Senger","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"2025112619451611000_18.11.e268656.6","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1093\/qjmed\/hcad111","article-title":"Pleuro-cutaneous fistula: a rare complication of tuberculosis","volume":"116","author":"Parikar","year":"2023","journal-title":"QJM"},{"key":"2025112619451611000_18.11.e268656.7","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.idcr.2017.06.009","article-title":"Bronchopleural and pleurocutaneous fistula in HIV patient with pulmonary tuberculosis","volume":"9","author":"Duarte-Ribeiro","year":"2017","journal-title":"IDCases"},{"key":"2025112619451611000_18.11.e268656.8","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0005737","article-title":"Broncho-pleuro-cutaneous fistula and pneumothorax: Rare challenging complications of chest wall eumycetoma","volume":"11","author":"Saad","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"2025112619451611000_18.11.e268656.9","unstructured":"Iguina MM , Danckers M . Thoracic empyema. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2024."},{"key":"2025112619451611000_18.11.e268656.10","unstructured":"Turner AR , Collier SA , Turner SD . Boerhaave syndrome. Treasure Island (FL): StatPearls Publishing, Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK430808\/"},{"key":"2025112619451611000_18.11.e268656.11","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000036411","article-title":"The clinical features and prognosis of fungal pleural infection: A case series and literature review","volume":"102","author":"Jing","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"2025112619451611000_18.11.e268656.12","article-title":"Progression and Resolution of a Post-traumatic Pleurocutaneous Fistula","volume":"15","author":"O\u2019Brien","year":"2023","journal-title":"Cureus"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-268656","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T03:45:22Z","timestamp":1764215122000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-268656"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":12,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,26]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bcr-2025-268656"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-268656","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}