To improve the clinical understanding of the characteristics, diagnosis and treatment methods and prognosis of empyema caused by Candida krusei infection.

The clinical data of a patient with empyema caused by Candida krusei infection admitted to the Second Affiliated Hospital of Nanjing Medical University in July 2022 was analyzed, retrospectively. Relevant literatures at home and abroad were searched to explore the pathogenesis, clinical characteristics, diagnosis and treatment of the disease.

This patient had a history of long-term drug abuse and bronchial asthma, and had severe hypoproteinemia at the initial stage of admission. After the diagnosis of Candida krusei empyema was confirmed, micafungin and voriconazole were given successively during chest drainage, and he was discharged after the empyema was completely absorbed. Total of 6 case reports (including 8 cases) of empyema caused by Candida krusei infection were retrieved, there were 4 patients with esophageal perforation, 2 patients with esophageal-tracheal fistula formation, and 1 patient after heart transplantation, 1 patient after occlusion of the ductus arteriosus; this patient had a bronchial-pleural fistula during the course of the disease; the initial clinical manifestations of this case and the 8 patients reported in the literature were cough, expectoration, and dyspnea, while the etiological diagnosis of empyema was all routine culture; according to the literatures, 4 cases among the 8 patients died, 1 patient was treated with amphotericin B, 2 patients with voriconazole, and 1 patient with echinocandin combined with voriconazole, and 1 case among the 4 survived patients was treated with echinocandin alone, 3 patients were treated with echinocandin combined with voriconazole.

This case of empyema caused by Candida krusei infection is the first reported case in China. Patients with this disease are more common inesophageal-tracheal fistula formation and surgical trauma, the clinical manifestations are not characteristic, treatment with echinocandoxin or combined with triazole voriconazole may improve the survival.