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The diagnosis of tuberculosis by X-ray radiogram is often confused with pulmonary carcinoma, bacillary and parasitic infections, and chronic mycosis. A case of pulmonary paragonimiasis misdiagnosed as tuberculosis by clinical history and X-ray radiogram is reported. A 48-year-old female was admitted to a hospital with chief complaints of hemoptysis and mild feve. She had denied of consume crabs before. On admission, a nodular shadow in the left upper lung on the chest X-ray and multiple small nodules and tunnel like shadow was detected in the lung on CT. Peripheral blood examination was not disclosed eosinophilia (5,300/mm3). Although we failed to detect any parasite eggs in stool, microscopic sputum exammination revealed an infection of paragonimus. Oral administration of praziquantel resulted in the disappearance of symptoms. With this case, the smears of sputum were checked by an inspection technician’s discernment, and Paragonimus eggs along with numerous eosinophils and Charcot-Leyden crystals were detected. In suspected cases of tuberculosis, a history of crab-eating plus sputum examinations, image findings, and serodiagnosis are necessary to rule out paragonimiasis.
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