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A 56 year old man with locally advanced oesophageal carcinoma was admitted with neutropenic (0.6 X [10.sup.9]/1) sepsis 10 days after chemotherapy with etoposide, cisplatin, and capecitabine. At presentation there was evidence of marked respiratory compromise and subsequent chest radiography demonstrated a large right sided pleural effusion. Diagnostic thoracocentesis revealed frank malodorous pus from which Candida albicans was repeatedly isolated. A large bore (32F) chest tube was inserted and he was started on intravenous broad spectrum antibiotics and fluconazole.
At initial diagnostic biopsy of malignancy a mediastinal perforation occurred which necessitated placement of a covered oesophageal stent. Consequently, there was a high clinical suspicion of abnormal ...