Candida mediastinitis is a rare condition characterized by a high mortality and chronic morbidity, Including the present review, only 39 cases have been described, 67% occurring after a cardiac operation. Candida mediastinitis has a 55% mortality in the postoperative setting and a mortality of 92% among patients without a prior cardiac procedure. Although no patient survived Candida mediastinitis without surgical drainage of the mediastinum, survival was 85% among 13 patients who underwent operative mediastinal drainage. Chronic wound infection developed in 6 survivors of operative drainage without muscle flap closure, but in all patients closed with vascularized flaps, healing ultimately occurred. Aggressive surgical management with mediastinal drainage, sternal debridement, and early wound closure with vascularized flaps are essential to minimize the otherwise high morbidity and mortality of Candida mediastinitis.