Uruga Hironori, Miyamoto Atsushi, Beika Yuka, Enomoto Takahiro, Takaya Hisashi, Morokawa Nasa, Kishi Kazuma, Yoshimura Kunihiko
Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital.
Nihon Kokyuki Gakkai Zasshi. 2009 Jun;47(6):476-80.
A 72-year-old man was admitted to our hospital because of a low grade fever and malaise. He had received a middle to lower esophagectomy and proximal gastrectomy with reconstruction of a gastric conduit for esophageal cancer 12 years previously. Chest X-ray and CT scan revealed massive pleural effusion and consolidations on the right side. Candida glabrata was isolated 4 times from pleural fluid specimens. Candida antigen was negative in both serum and pleural effusion. However, while serum beta-D-glucan was negative, the level of beta-D-glucan in pleural effusion was extremely elevated. Thus, the patient was diagnosed as having C. glabrata empyema. He was treated with insertion of a thoracostomy tube followed by intrapleural instillation of amphotericin B and intravenous administration of micafungin. Pleural effusion was reduced and the repeated culture of the pleural effusion became negative after 27 days of treatment. Empyema with C. glabrata is rare and the present case is the second report of the disease in the Japanese literature.
一名72岁男性因低热和全身不适入院。12年前他因食管癌接受了食管中下段切除术和近端胃切除术，并采用胃管道重建术。胸部X线和CT扫描显示右侧大量胸腔积液和实变。从胸腔积液标本中4次分离出光滑念珠菌。血清和胸腔积液中的念珠菌抗原均为阴性。然而，血清β-D-葡聚糖为阴性，而胸腔积液中的β-D-葡聚糖水平极度升高。因此，该患者被诊断为光滑念珠菌性脓胸。他接受了胸腔造瘘管置入术，随后胸腔内注入两性霉素B并静脉注射米卡芬净治疗。治疗27天后，胸腔积液减少，胸腔积液的重复培养转为阴性。光滑念珠菌性脓胸罕见，本病例是日本文献中该疾病的第二例报道。
