Khan Yasir, Hussain Munawar, Shahabuddin Syed
Section of Cardiothoracic, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Section of Cardiothoracic, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Int J Surg Case Rep. 2019;57:25-27. doi: 10.1016/j.ijscr.2019.02.040. Epub 2019 Mar 7.
Fungal empyema a rare cause of empyema thoracis is commonly associated with nosocomial infection or gastrointestinal disease with very high mortality. Its association with chronic pancreatitis is rarely been described.
We present a case of young male known alcoholic with chronic pancreatitis and cystgastrostomy who presented with dyspnea and fever. Thorough workup showed left sided amylase rich loculated pleural effusion. Culture grew candida albicans. Esophagogram carried out for any esophageal rupture turned out to be negative. Histopathology was negative for malignancy. Intraoperative left sided yellowish colour fluid was drained, Loculation broken and rind removed. No pleuro-peritoneal fistula could be identified. Postoperatively patient remained well and discharged on antifungal.
No obvious cause of fungal empyema could be found except for pancreatico-pleural spread as suggested by amylase rich pleural effusion along with growth of candida spp. Hence in patient with chronic pancreatitis and cystgastrostomy pleural effusion should be evaluated for fungal infection to avoid morbidity and mortality and commence early treatment.
真菌性脓胸是脓胸的一种罕见病因，通常与医院感染或胃肠道疾病相关，死亡率很高。其与慢性胰腺炎的关联鲜有报道。
我们报告一例年轻男性病例，该患者为已知的酗酒者，患有慢性胰腺炎并接受了囊肿胃造口术，出现呼吸困难和发热症状。全面检查显示左侧有富含淀粉酶的包裹性胸腔积液。培养结果为白色念珠菌生长。为排查食管破裂而进行的食管造影结果为阴性。组织病理学检查排除恶性肿瘤。术中引流出左侧淡黄色液体，打破包裹并清除脓壁。未发现胸膜-腹膜瘘。术后患者情况良好，出院时接受抗真菌治疗。
除了富含淀粉酶的胸腔积液以及念珠菌属生长提示的胰-胸膜播散外，未发现真菌性脓胸的明显病因。因此，对于患有慢性胰腺炎和囊肿胃造口术的患者，应评估胸腔积液是否存在真菌感染，以避免发病和死亡，并尽早开始治疗。
