{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T14:58:34Z","timestamp":1782226714673,"version":"3.54.5"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T00:00:00Z","timestamp":1657152000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T00:00:00Z","timestamp":1657152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"JSPS KAKENHI","award":["JP22K16250"],"award-info":[{"award-number":["JP22K16250"]}]},{"name":"JSPS KAKENHI","award":["JP21K08238"],"award-info":[{"award-number":["JP21K08238"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Invasive pulmonary aspergillosis (IPA) is a serious complication occurring in immunocompromised patients, who often show multiple nodular lesions with or without cavitation. Due to high mortality and poor prognosis, the earlier detection and initiation of treatment are needed, while the definitive diagnosis is often difficult to make in clinical settings. Septic pulmonary embolism (SPE) is a complication that occurs in patients with bloodstream infections (e.g., infectious endocarditis). Patients with SPE also present with multiple nodules, nodules with or without cavitation, which are quite similar to the findings of IPA. We herein report an autopsy case that showed multiple nodules due to IPA and infectious endocarditis-related SPE.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case<\/jats:title>\n                <jats:p>A 69-year-old man receiving maintenance hemodialysis due to diabetic nephropathy was admitted with worsening skin rash due to bullous pemphigoid and toxic epidermal necrolysis. He was treated with intravenous methylprednisolone followed by an increased dose of oral prednisolone. On the 6th week of admission, he was diagnosed with infectious endocarditis after the isolation of <jats:italic>Corynebacterium<\/jats:italic> in blood samples, with a nodule lesion with cavitation in the right lung. Intravenous vancomycin was initiated. After antibacterial treatment, the nodules in the right lung gradually diminished, whereas a nodule with cavitation in the left lung emerged. The nodule in the left lung showed rapid growth along with elevation of serum \u03b2-<jats:sc>d<\/jats:sc>-glucan and galactomannan antigen. Despite starting treatment with antifungal agents, he died from respiratory failure. An autopsy revealed Groccott staining-positive aspergillus in the left lung, but not in the right lung. We found fibrosis with mitral valve vegetation, indicating a recovery from infectious endocarditis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Although similar features of nodules with cavitation on CT imaging were shared with SPE and IPA, this case demonstrated that these heterogeneous diseases can occur within the lungs and the distinctly different transitions of CT imaging are helpful for suspecting the presence of multiple pathogeneses.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-022-07566-1","type":"journal-article","created":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T13:06:28Z","timestamp":1657199188000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Two entities in pulmonary nodules of a diabetic patient receiving corticosteroid therapy for bullous pemphigoid: an autopsy case report"],"prefix":"10.1186","volume":"22","author":[{"given":"Reimi","family":"Mizushima","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1918-0390","authenticated-orcid":false,"given":"Kotaro","family":"Haruhara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nei","family":"Fukasawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Satake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Fukui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Koike","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuo","family":"Tsuboi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Yokoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,7,7]]},"reference":[{"issue":"Pt 1","key":"7566_CR1","first-page":"231","volume":"28","author":"RS Fraser","year":"1993","unstructured":"Fraser RS. Pulmonary aspergillosis: pathologic and pathogenetic features. Pathol Annu. 1993;28(Pt 1):231\u201377.","journal-title":"Pathol Annu"},{"issue":"12","key":"7566_CR2","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.1086\/588660","volume":"46","author":"B De Pauw","year":"2008","unstructured":"De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pappas PG, Maertens J, Lortholary O, Kauffman CA, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer\/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC\/MSG) Consensus Group. Clin Infect Dis. 2008;46(12):1813\u201321.","journal-title":"Clin Infect Dis"},{"issue":"3","key":"7566_CR3","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1086\/509917","volume":"44","author":"RE Greene","year":"2007","unstructured":"Greene RE, Schlamm HT, Oestmann JW, Stark P, Durand C, Lortholary O, Wingard JR, Herbrecht R, Ribaud P, Patterson TF, et al. Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Clin Infect Dis. 2007;44(3):373\u20139.","journal-title":"Clin Infect Dis"},{"key":"7566_CR4","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.631461","volume":"8","author":"L Liu","year":"2021","unstructured":"Liu L, Gu Y, Wang Y, Shen K, Su X. The clinical characteristics of patients with nonneutropenic invasive pulmonary aspergillosis. Front Med (Lausanne). 2021;8: 631461.","journal-title":"Front Med (Lausanne)"},{"issue":"1","key":"7566_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.rmed.2013.10.012","volume":"108","author":"R Ye","year":"2014","unstructured":"Ye R, Zhao L, Wang C, Wu X, Yan H. Clinical characteristics of septic pulmonary embolism in adults: a systematic review. Respir Med. 2014;108(1):1\u20138.","journal-title":"Respir Med"},{"issue":"6","key":"7566_CR6","doi-asserted-by":"publisher","first-page":"400","DOI":"10.6061\/clinics\/2015(06)03","volume":"70","author":"DW Chou","year":"2015","unstructured":"Chou DW, Wu SL, Chung KM, Han SC. Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses. Clinics (Sao Paulo). 2015;70(6):400\u20137.","journal-title":"Clinics (Sao Paulo)"},{"issue":"6","key":"7566_CR7","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1056\/NEJMcps031794","volume":"350","author":"AA Hilliard","year":"2004","unstructured":"Hilliard AA, Weinberger SE, Tierney LM Jr, Midthun DE, Saint S. Clinical problem-solving. Occam\u2019s razor versus Saint\u2019s Triad. N Engl J Med. 2004;350(6):599\u2013603.","journal-title":"N Engl J Med"},{"issue":"2","key":"7566_CR8","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1148\/radiology.190.2.8284408","volume":"190","author":"SL Primack","year":"1994","unstructured":"Primack SL, Hartman TE, Lee KS, M\u00fcller NL. Pulmonary nodules and the CT halo sign. Radiology. 1994;190(2):513\u20135.","journal-title":"Radiology"},{"issue":"6","key":"7566_CR9","doi-asserted-by":"publisher","first-page":"817","DOI":"10.3109\/13693780903514872","volume":"48","author":"MA Milito","year":"2010","unstructured":"Milito MA, Kontoyiannis DP, Lewis RE, Liu P, Mawlawi OR, Truong MT, Marom EM. Influence of host immunosuppression on CT findings in invasive pulmonary aspergillosis. Med Mycol. 2010;48(6):817\u201323.","journal-title":"Med Mycol"},{"issue":"2","key":"7566_CR10","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1177\/0300060518811472","volume":"47","author":"X Wang","year":"2019","unstructured":"Wang X, Guo G, Cai R, He P, Zhang M. Utility of serum galactomannan antigen testing combined with chest computed tomography for early diagnosis of invasive pulmonary aspergillosis in patients with hematological malignancies with febrile neutropenia after antifungal drug treatment. J Int Med Res. 2019;47(2):783\u201390.","journal-title":"J Int Med Res"},{"issue":"9","key":"7566_CR11","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1016\/S1726-4901(08)70146-1","volume":"71","author":"PW Yang","year":"2008","unstructured":"Yang PW, Lin HD, Wang LM. Pyogenic liver abscess associated with septic pulmonary embolism. J Chin Med Assoc. 2008;71(9):442\u20137.","journal-title":"J Chin Med Assoc"},{"issue":"3","key":"7566_CR12","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1016\/j.jinf.2006.04.008","volume":"54","author":"SJ Lee","year":"2007","unstructured":"Lee SJ, Cha SI, Kim CH, Park JY, Jung TH, Jeon KN, Kim GW. Septic pulmonary embolism in Korea: microbiology, clinicoradiologic features, and treatment outcome. J Infect. 2007;54(3):230\u20134.","journal-title":"J Infect"},{"issue":"4","key":"7566_CR13","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/ciw326","volume":"63","author":"TF Patterson","year":"2016","unstructured":"Patterson TF, Thompson GR 3rd, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63(4):e1\u201360.","journal-title":"Clin Infect Dis"},{"key":"7566_CR14","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.rmed.2018.06.029","volume":"141","author":"A Kanj","year":"2018","unstructured":"Kanj A, Abdallah N, Soubani AO. The spectrum of pulmonary aspergillosis. Respir Med. 2018;141:121\u201331.","journal-title":"Respir Med"},{"issue":"11\u201312","key":"7566_CR15","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1046\/j.1439-0507.1999.00508.x","volume":"42","author":"Y Zhirong","year":"1999","unstructured":"Zhirong Y, Wanqing L, Weihua P. Case reports. Invasive pulmonary aspergillosis in non-neutropenic patients treated with liposomal amphotericin B. Mycoses. 1999;42(11\u201312):679\u201382.","journal-title":"Mycoses"},{"issue":"1","key":"7566_CR16","doi-asserted-by":"publisher","first-page":"174","DOI":"10.4103\/1319-2442.174208","volume":"27","author":"M Jabrane","year":"2016","unstructured":"Jabrane M, Skandour D, Rochdi Y, Nouri H, Aderdour L, Raji A, Alaoui C, Fadili W, Laouad I. Severe forms of aspergillosis in patients on hemodialysis. Saudi J Kidney Dis Transpl. 2016;27(1):174\u20136.","journal-title":"Saudi J Kidney Dis Transpl"},{"issue":"5","key":"7566_CR17","doi-asserted-by":"publisher","first-page":"936","DOI":"10.3904\/kjim.2015.056","volume":"32","author":"JH Seo","year":"2017","unstructured":"Seo JH, Kim JA, Choi B, Kim KH, Park HN, Seok H, Sohn TS. Hyperglycemic hyperosmolar state associated with invasive rhino-orbital aspergillosis in a patient with end-stage renal disease. Korean J Intern Med. 2017;32(5):936\u20138.","journal-title":"Korean J Intern Med"},{"issue":"10","key":"7566_CR18","doi-asserted-by":"publisher","first-page":"2687","DOI":"10.1093\/ndt\/gfh418","volume":"19","author":"AO Sahl\u00e9n","year":"2004","unstructured":"Sahl\u00e9n AO, Suvarna SK, Wilkie ME. A case of invasive pulmonary aspergillosis in renal failure. Nephrol Dial Transplant. 2004;19(10):2687.","journal-title":"Nephrol Dial Transplant"},{"key":"7566_CR19","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.mmcr.2017.06.006","volume":"18","author":"N Cicek","year":"2017","unstructured":"Cicek N, Yildiz N, Kadayifci EK, Gokce I, Alpay H. Invasive aspergillosis in a patient with end stage renal disease. Med Mycol Case Rep. 2017;18:12\u20134.","journal-title":"Med Mycol Case Rep"},{"issue":"8","key":"7566_CR20","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1111\/myc.12926","volume":"62","author":"P Koehler","year":"2019","unstructured":"Koehler P, Salmanton-Garc\u00eda J, Gr\u00e4fe SK, Koehler FC, Mellinghoff SC, Seidel D, Steinbach A, Cornely OA. Baseline predictors influencing the prognosis of invasive aspergillosis in adults. Mycoses. 2019;62(8):651\u20138.","journal-title":"Mycoses"},{"issue":"4","key":"7566_CR21","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1128\/JCM.06423-11","volume":"50","author":"J D'Haese","year":"2012","unstructured":"D\u2019Haese J, Theunissen K, Vermeulen E, Schoemans H, De Vlieger G, Lammertijn L, Meersseman P, Meersseman W, Lagrou K, Maertens J. Detection of galactomannan in bronchoalveolar lavage fluid samples of patients at risk for invasive pulmonary aspergillosis: analytical and clinical validity. J Clin Microbiol. 2012;50(4):1258\u201363.","journal-title":"J Clin Microbiol"},{"issue":"3","key":"7566_CR22","doi-asserted-by":"publisher","first-page":"22","DOI":"10.3390\/jof2030022","volume":"2","author":"F Lamoth","year":"2016","unstructured":"Lamoth F. Galactomannan and 1,3-\u03b2-d-glucan testing for the diagnosis of invasive aspergillosis. J Fungi (Basel). 2016;2(3):22.","journal-title":"J Fungi (Basel)"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-022-07566-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-022-07566-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-022-07566-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T13:06:59Z","timestamp":1657199219000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-022-07566-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,7]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["7566"],"URL":"https:\/\/doi.org\/10.1186\/s12879-022-07566-1","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,7]]},"assertion":[{"value":"27 December 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 July 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Before the autopsy, we obtained written informed consent for autopsy and the publication of this report, including personal and clinical details along with identified images, from the patient\u2019s family.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no conflicts of interest in association with the present study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"597"}}