Paragonimiasis is a food-borne parasitic infection resulting from ingestion of undercooked crustaceans. Whereas uncommon in the United States, Paragonimus species are endemic in North America, South America, Asia, and Africa. Pulmonary symptoms are most common, but cerebral, dermatologic, and abdominal variations are recognized. Diagnosis is supported by positive serologic findings and a typical exposure history. Pathologic confirmation by visualization of eggs, however, is preferred. In the subsequent case presentation, we elucidate an instance of pulmonary paragonimiasis mimicking tuberculosis in a middle-aged Burmese female.