Abstract: The number of pulmonary tuberculosis (PTB) cases in Indonesia is second ranks in the world. South Sulawesi contributes significantly to the increase of PTB cases in Indonesia. This study explored the spatial dynamics of PTB cases in the highlands and lowlands of Gowa regency, South Sulawesi. This study aimed to present spatial patterns of TB spread in highland and lowland areas in gowa district based on environmental health parameters that will assist in formulating prevention policies and regional-based control strategies.This study used quantitative with spatial analysis approach. The respondents of this study were all registered PTB patients on medical records in the PTB control unit at Health Center in the highlands and lowlands of Gowa regency. Total sample of this research was 156 respondents, derived from 57 in highland and 99 in lowland. Territorial analysis was applied to detect PTB spatial patterns in two regions with different elevation. The variables in this study focused on environmental characteristics in each region.PTB Prevalence in lowland was relatively higher than highland. Temperature and density of occupancy were the determinants of the high prevalence of PTB in the lowlands. At the highland, humidity factor, ventilation area, floor and wall condition were high contributing to PTB incidence (more than 60%). meanwhile, on the lowland, those factors were not significant.This study identified the PTB spatial distribution of highland and lowland by analyzing cases per 100,000 peoples and could be used to develop effective strategies for PTB prevention and control by exploring environmental health factors of public health.