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 X-ray radiogram is reported. With this case, the smears of sputum were rechecked 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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