Background : Hemoptysis is one of the often symptoms that complained in respiratory disease with fungal Infection. Jakarta reported that prevalency of Invasive Pulmonary aspergillosis is 7,7% and Pneumocystis pneumonia is 14.5%. Lung mycosis is still difficult to diagnosed so the management of therapy is often too late. The risk factors of lung mycosis in these patient are immunocompromised conditions with Diabetes Melitus, history of Tuberculosis treatment and COPD. The diagnosis criteria of systemic/invasive mycosis are proven, probable and possible. Proven criteria diagnosed is based on host factor, clinical finding and mycology whereas possible criteria diagnosed is based on host factor and clinical finding without mycology.Case Report: We report one case at Dr. Saiful Anwar hospital, Man, 43 years old with History of Tuberculosis Treatment and suspected as Lung Mycosis with chef complained hemoptoe recurrent in last 2 months, shortness of breath, cough, right chest pain, fever, night sweating and decrease of body weight 1-2kg in a month. From the physical examination we found percussion dullness and decreased of lung sound in the right upper thorax examination and laboratory results and chest xray there are suspicion of Aspergillosis. The results of XpertMtb/Rif sputum examination obtained that no Mycobacterium tuberculosis, sputum KOH was not found fungus, cytological sputum was obtained as Class II, and in bacterial sputum culture obtained Klebsiella pneumonia. The patient performed a bronchoscopic examination and continued with open thoracotomy surgery and lobectomy.Conclusion: In these patient the diagnosis of lung mycosis with suspicious of Aspergillosis has gone through a multidisciplinary approach covering the pulmonology, radiology, microbiology and anatomical pathology. Collaboration between doctors, researchers, and the pharmaceutical industry is required to resolve the problem of fungal diseases and can increase the profile of these diseases.

Introduction: Pleural tuberculosis is a pleural infection of tuberculosis caused by Mycobacterium tuberculosis which commonly manifests as hydropneumothorax. Initial treatment with anti-tuberculosis drugs is aimed to prevent progression of the disease and relieve patient’s symptoms. Indication of adhesiolysis and decortication is to remove layer of fibrous tissue and allow the lung to reexpand. Case: A 60 year old woman with shortness of breath, cough, and right-sided chest pain. She had a history of treatment with first-line anti-tubercular drugs for a year stop in September 2016. She was identified with recurrent right-sided hydropneumothorax by chest imaging and thorax CT-scan. Adhesiolysis and decortication were performed on her. Two months later she was diagnosed again with recurrent right-sided hydropneumothorax. VATS (Video-Assisted Thoracoscopic Surgery) revealed fistula involving inferior lobe of the lung. Then, she was treated with second-line anti tuberculosis drugs. After four times reccurent hydropneumothorax, patient showed significant improvement in clinical condition, radiology finding, and lung function test after she finished the tuberculosis treatment. Discussion: Definitive diagnosis of pleural tuberculosis is by the finding of mycobacterium tuberculosis in pleural biopsy, or Mtb culture, and it was difficult to perform. In this case pleural fluid analysis revealed that cause of recurrent right-sided hydropneumothorax was tuberculosis infection. Summary: A 60 year old woman with four times reccurent right-sided hydropneumothorax, and the pleural fluid analysis suggested it was tuberculosis infection. Providing anti-tuberculosis medication based on clinically diagnosed tuberculosis based on flowchart of tuberculosis diagnosis from national tuberculosis programmed are essential to prevent progression of the disease.

Background: Although classified as a rare disease, the global burden of disease study reports showed that interstitial lung disease is ranked 40th in the diseases with high mortality, and its prevalence had increased by 86% since 1990. The most common interstitial lung disease”idiopathic pulmonary fibrosis (IPF)”has low survival rates”2-3 years after diagnosis”and is irreversible. Establishing a definite diagnosis of IPF is very difficult because it needs a multidisciplinary approach, as an establishment based on the description of HRCT and lung biopsy is needed. The goal of therapy is to prevent the progression of fibrosis. Case: We report a case of an adult woman, 46 years old with idiopathic pulmonary fibrosis (IPF) with Probable Usual Interstitial Pneumonia (UIP) pattern at dr. Saiful Anwar Hospital. History taking, physical examination and laboratory and chest Xray examination of the patient found a suspicion of ILD. CT-scan showed fibrosis in both lungs, honeycomb appearance with pulmonary bronchiectasis traction, which fit the description of IPF, and thus suspended the diagnosis of ILD. VATS pulmonary biopsy confirmed the diagnosis of IPF. The patient experienced a decrease in clinical conditions, as her complaint was worsening in the last month, in accordance to the state of acute exacerbations. Conclusion: In this patient, the diagnosis of IPF with Probable UIP pattern was made through a multidisciplinary approach, including the pulmonology, radiology and anatomical pathology department.