{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T05:03:32Z","timestamp":1784351012364,"version":"3.55.0"},"reference-count":10,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Surgical Infections"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Fungal empyema is uncommon and has worse short-term outcomes than bacterial disease, particularly when a bronchopleural fistula (BPF) sustains contamination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>\n                      A previously healthy male developed BPF and methicillin-resistant\n                      <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                      (MRSA) empyema after right upper lobectomy at age 17, managed by open-window thoracostomy (OWT). An apical residual space persisted and formed a fungus-ball-like nodule. At age 30, he re-presented with fever and nodule growth, with elevated\n                      <jats:italic toggle=\"yes\">Aspergillus<\/jats:italic>\n                      IgG; voriconazole was started.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management:<\/jats:title>\n                    <jats:p>\n                      Computed tomography-guided catheter placement and re-OWT exposed air leaks and recurrent MRSA. Staged fistula control with endobronchial Watanabe spigots,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      -butyl-2-cyanoacrylate, and cavity-side suturing achieved cessation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome:<\/jats:title>\n                    <jats:p>After irrigation, sterilized cultures, negative-pressure therapy preceded latissimus dorsi flap obliteration. He was discharged on postoperative day 149 without recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      A stepwise plan\u2014source control, fistula control, sterilization, and obliteration\u2014can achieve durable cure in mixed\n                      <jats:italic toggle=\"yes\">Aspergillus<\/jats:italic>\n                      \u2013MRSA empyema with BPF after prior OWT.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10962964251407580","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T13:03:08Z","timestamp":1767099788000},"page":"449-452","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Late Recurrence of Empyema More Than a Decade after Window Thoracostomy: Secondary\n                    <i>Aspergillus<\/i>\n                    Infection Superimposed on Prior MRSA Empyema, Successfully Managed by Stepwise Surgical and Endobronchial Definitive Closure"],"prefix":"10.1177","volume":"27","author":[{"given":"Kaoru","family":"Kondo","sequence":"first","affiliation":[{"name":"Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruchika","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumi","family":"Nakashima","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidejiro","family":"Torigoe","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Suzawa","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiko","family":"Shien","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaroh","family":"Miyoshi","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikio","family":"Okazaki","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiichiro","family":"Sugimoto","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Toyooka","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-022-07978-z"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.117.6.1672"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mmcr.2014.07.006"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2017-222143"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202210-868OC"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000031080"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.914529"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/5179292"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw353"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmcr.2020.101123"}],"container-title":["Surgical 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