Septic shock due to invasive pulmonary aspergillosis without conventional risk factors.

was drowsy, with blood pressure 69/37 mm Hg, heart rate 75 beats/min, respiratory rate 22 beats/min, body temperature 36.9 °C, and pulse oxygen saturation 60% at room air. Coarse breath sounds with crackles were heard in both lung fields. Concurrent with mechanical ventilation, adequate intravenous fluid and norepinephrine were administered. The initial serum lactate level was elevated to 2.5 mmol/L. Chest radiograph showed increased opacities mainly in the right lower lung field (Figure 1A). Chest computed tomography revealed multifocal nodules with surrounding ground-glass opacities (GGOs), the “halo sign” in underlying emphysematous lungs, and extensive consolidation with GGO in both lower lobes (Figure 2A and B). The initial white blood cell and absolute neutrophil counts were 3,110/μl and 2,430/μl, which increased to 8,430/μl and 6,830/μl on the second day, respectively. Non-specific erythematous bronchial mucosa with a large amount of thick, purulent sputum was observed on bronchoscopy