Allergic bronchopulmonary aspergillosis with metachronous isolation of three distinct species.

Allergic bronchopulmonary aspergillosis (ABPA) is an inflammatory disease induced by exaggerated immune responses to species. Although ABPA has a high recurrence (48%), its instances with sequential isolation of distinct species are sporadic. Only one case report has documented the metachronous isolation of and . However, no reported cases of metachronous isolation involving three distinct species exist. Herein, we report a novel case of a 47-year-old Japanese man with sequential metachronous isolation of , , and . Initially presenting with symptoms of productive cough and pulmonary infiltration, the patient experienced two relapses following treatment with oral prednisolone. Adjustments in therapy, including voriconazole and a tailored corticosteroid regimen, resulted in significant improvement without relapse for over 6 months. This case report highlights the challenges and successful management of ABPA involving multiple species.