{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T04:18:13Z","timestamp":1787804293348,"version":"build-2784847793"},"reference-count":5,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology Case Reports"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Drug\u2010induced lung injury (DILI) may present with diverse radiological and histopathological manifestations. We report a case of dietary supplement\u2010associated DILI presenting as multiple randomly distributed pulmonary nodules mimicking metastatic malignancy and histopathologically exhibiting an acute fibrinous and organizing pneumonia (AFOP) pattern. A 62\u2010year\u2010old man who had taken a dietary supplement containing fermented grain extract, malt extract, and coenzyme Q10 for approximately 15\u2009years developed multiple pulmonary nodules accompanied by marked peripheral eosinophilia. Computed tomography initially raised suspicion of metastatic malignancy. Bronchoalveolar lavage demonstrated eosinophilia, and transbronchial lung cryobiopsy revealed an AFOP pattern with prominent eosinophilic inflammation. The diagnosis of dietary supplement\u2010associated DILI was established based on the exposure history, exclusion of alternative diagnoses, and spontaneous regression of the pulmonary nodules and improvement in eosinophilia following discontinuation of the dietary supplement. This case highlights that dietary supplement\u2010associated DILI may mimic metastatic malignancy by presenting as multiple pulmonary nodules, while histopathological evaluation may reveal an AFOP pattern with marked eosinophilic inflammation.<\/jats:p>","DOI":"10.1002\/rcr2.70735","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T06:59:15Z","timestamp":1787641155000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Mimic of Metastatic Malignancy: Dietary Supplement\u2010Associated Drug\u2010Induced Lung Injury Presenting as Multiple Pulmonary Nodules With an Acute Fibrinous and Organizing Pneumonia Pattern"],"prefix":"10.1002","volume":"14","author":[{"given":"Yuto","family":"Goto","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine and Clinical Immunology Dokkyo Medical University School of Medicine  Tochigi 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School of Medicine  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Kawabe","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Pathology Dokkyo Medical University School of Medicine  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Arakawa","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery Dokkyo Medical University, School of Medicine  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Takemasa","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine and Clinical Immunology Dokkyo Medical University School of Medicine  Tochigi Japan"},{"name":"Respiratory Endoscopy Center Dokkyo Medical University Hospital  Tochigi 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