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We report an unusual case of paragonimiasis in a Nepali patient presenting with massive pericardial effusion and pericardial tamponade. The patient reported neither the consumption of crabs or crayfish nor the consumption of wild animal meat, which are the usual sources of infection. It is suspected that the source of infection was instead the ingestion of raw live slugs as part of a traditional medicine treatment.

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The authors report a case of coinfection of pulmonary paragonimiasis and pulmonary tuberculosis which is an uncommon coinfection. The patient presented with a one-week history of nonmassive hemoptysis about 1 month after completion of treatment for smear-negative pulmonary tuberculosis (sputum polymerase chain reaction positive for Mycobacterium tuberculosis). She lived in Nakhon Nayok province and reported taking raw crabs from time to time.

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Infections caused by the parasite Paragonimus westermani are endemic to Southeast Asia. Most infections reported in the United States are among immigrants who acquired the disease abroad. Due to the nonspecific nature of its presentation and rarity in the United States, the diagnosis may first be suggested by the pathologist on biopsy review.

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