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All Journal Journal of Innovation and Applied Technology MNJ (Malang Neurology Journal) Universa Medicina Majalah Kesehatan FKUB Indonesian Journal of Medicine Jurnal Respirologi Indonesia Jurnal Respirasi (JR) Respiratory Science Malang Respiratory Journal Indonesian Journal of Cancer International Journal of Radiology and Imaging Journal of Community Health and Preventive Medicine (JOCHAPM)
Dini Rachma Erawati
Department Of Radiology, Faculty Of Medicine, Universitas Brawijaya/Dr. Saiful Anwar General Hospital, Malang, Indonesia.
Biochemistry, Genetics & Molecular Biology Computer Science & IT Dentistry Education Environmental Science Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Other

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Successful Lobectomy for Lung Aspergilloma Post–Tuberculosis Infection with Recurrent Hemoptysis Gregorio Satrio Pinunggul; Christian Surya Eka Putra; Rezki Tantular; Dini Rachma Erawati; Nurima Diyah; Koernia Kusuma Wardhana
Jurnal Respirologi Indonesia Vol 46 No 3 (2026)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v46i3.1061

Abstract

Background: Aspergilloma is a colonization of a lung cavity by the fungus Aspergillus, which often occurs as a result of a prior tuberculous lesion. Thus, a multimodal approach is needed to be more effective at reducing recurrence and mortality. Case: A 45-year-old male smoker came with complaints of recurrent hemoptysis for one year, followed by shortness of breath. The patient was diagnosed with tuberculosis twice, both diagnoses confirmed bacteriologically and declared cured. The CT scan of the thorax with contrast concluded that the pulmonary tuberculosis was inactive, displaying a fungus ball at the apex of the left lung accompanied by multiple subpleural blebs. Lobectomy was performed to remove the fungus ball. The results of the biopsy showed pieces of aspergillosis fungal tissue with a fungus ball appearance accompanied by necrosis. Oral voriconazole was given as postoperative treatment for 7 days and continued with itraconazole for 6 months. The patient experienced clinical improvement and was able to return to activities during follow-up. Discussion: Lobectomy is often optimal despite its morbidity risks. The X-ray that reveals a residual space or hydropneumothorax also mandates prolonged water-seal drainage and strict observation according to protocol. Additionally, postoperative triazoles completely eradicated the disease. Conclusion: Surgery is a fairly effective treatment in cases of aspergilloma with recurrent hemoptysis. Surgical intervention allows for the complete removal of the fungal ball, its enclosing cavity, and the adjacent unhealthy lung tissue. Multidisciplinary and comprehensive treatment needs to be carried out to increase life expectancy and reduce the recurring symptoms.
Case Series: Uncommon and Compound Mutations Exon 19 Deletion/20 Insertion and Exon 21 L858R/V834L in Lung Adenocarcinoma Hendro Suryadi; Ungky Agus Setyawan; Yani Jane Sugiri; Dini Rachma Erawati; Hendy Setyo Yudhanto; Sastia Rakhma
Jurnal Respirasi Vol. 12 No. 3 (2026): September 2026
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v12-I.3.2026.258-266

Abstract

Introduction: Mutation in lung adenocarcinoma pose significant challenges in lung malignancy management. Next‑generation sequencing can reveal uncommon variants and drug‑resistance mechanisms that require personalized therapy. Case: First case, 68 years old female diagnosed with lung nodules since 2021 without regular check-ups. In September 2023, the patient diagnosed with Left Lung Adenocarcinoma T4N2M1b stage IVA with EGFR exon 20 insertion but she refused chemotherapy and got afatinib for seven months until the symptoms re-occurred. EGFR with NGS in March 2024 showed additional exon 19 deletion and afatinib continued till the patient showing grade III cutaneous–gastrointestinal adverse effects and followed by dosage adjustment Patient's condition worsened in June 2024. Second case, 61 years old female diagnosed with right lung adenocarcinoma T4N2M1c Stage IVB with exon 21 L858R in January 2022. Patient underwent afatinib therapy showing good results. After 24 months, subsequently became symptomatic, and EGFR testing detected additional T790M EGFR gene leading treatment change to osimertinib with unsatisfactory results. NGS-liquid biopsy in May 2024 showed compound mutation exon 21 L858R - exon 21 V834L with resistance to osimertinib. Patient’s condition worsened in August 2024. Conclusion: Lung adenocarcinoma can mutate to not only uncommon but also rare mutations, such as exon 20 insertion and V834L, leading to TKI resistance despite the patient's clinical improvement. This represents a significant therapeutic challenge in the management of adenocarcinoma and requires a comprehensive, personalized treatment approach. Keywords: Adenocarcinoma, Uncommon mutation, Drug Resistance
Co-Authors Adinda Amalia Dani Aditya Rahman, Perdana Aditya Sri Listyoko Aditya, Aldo Adolf Nggay, Andriana Agus Setyawan, Ungky Akbar, Jimmy Akbar Andri Andri Ari Irawan ARIFAH ARIFAH Astuti, Tri Wahyu Azmi, Mukhammad Binharyanto, Adlan Pratama Binharyanto Chozin, Iin Noor Chozin, Iin Nur Christian Surya Eka Putra Desfryda, Elynca Putri Djajalaksana, Susanthy Djanggan Sargowo Dwi Pratiwi, Suryanti Dwinadella, Sephia Eka Agustina, Dwi Rosa Elisabeth, Gracelia Elvira Sari Dewi Falyani, Silvy Amalia Gracelia Ruth Elisabeth Damanik Gregorio Satrio Pinunggul Handono Kalim hardiyanto, frenky Hendro Suryadi Hendy Setyo Yudhanto Hendy Setyo Yudhanto Hendy Setyo Yudhanto Hustorio Aliongko Simamora Iin Noor Chozin Imam Suseno Indah Sari, Fitri Isharanto, Artono Jane Sugiri, Yani Jani, Jane R Sugiri Jeffry Beta Tenggara Koernia Kusuma Wardhana Krisdiyanto, Peter Kristianto, Fransiskus Kristina Paskalita Kero Kusuma Wardhana, Koernia Kusworini Handono Listyoko, Aditya Sri Lyono, Albert Mahendra, Reza Aditya Maleachi, Reginald Mira Yuniarti Mohammad Faridza Setyo Hadikusumab Muhammad Zacky Hafiyyan Maulana Ngakan Putu Parsama Putra Noor Chozin, Iin Nurandhini, Marsha Nurdiana Nurdiana Nurima Diyah Oktavinayu Sari Latif Parsama Putra, Ngakan Putu Parsama, Ngakan Putu Putra Pratama, Mirza Zaka Pratiwi, Suryanti Dwi Pudjo, Herwindo Putri, Choirinnisa Meilia Ayu R. Sugiri, Yani Jane Rahayu Sartono, Teguh Rakhma , Sastia Rakhma, Sastia Retnani, Diah Prabawati Rezki Tantular Rezki Tantular Rini, Ni Made Rumaratu, Simon Petrus Hardiyanto santony, Santony Santoso, Agus Andreas Sari, Tita Luthfia Sastia Rakhma Semara Putra, Wayan Wahyu Setiadi, Satya Setiawan, Ungky Agus Setyawan, Ungky Agus Setyo Yudhanto, Hendy Sigiro, Rahel Margareth Febriana Soewondo, Widiastuti Sri Andarini Sugiri, Yani Jane R. Sugiri, Yani Jane Rosihaningsih Suryanti Dwi Pratiwi Susanthy Djajalaksana Susanthy Djajalaksana Susanti, Lia Sutedjo, Verawati Tantular, Rezki Tjakraatmadja, Ricardo Trimurtini, Asih Triwahju Astuti Ungky Agus Setyawan Wahono, Cesarius Singgih Wahyudy Prasetyo, Kevin Wantry, Kenty Wardhana, Koernia Kusuma Wardhana, Kurnia Winarni, Tika Wahyu Wisnu Barlianto Yani Jane R. Sugiri Yani Jane Sugiri Yudhanto, Hendi Setyo Yudhanto, Hendy Setyo Yusdianto, Adrian Yuyun Yueniwati Zaenal Kusuma