A 27-year-old female patient from Laos, with a history of consuming raw freshwater crabs, had been residing in Wuhu City, Anhui Province for the past six months. On April 22, 2025, she presented to the First Affiliated Hospital of Wannan Medical College with a one-year history of recurrent cough and expectoration. Her chest CT revealed infectious lesions in both lungs with multiple cavities, cystic changes, and a small amount of pleural effusion on both sides. The blood routine test showed elevated absolute eosinophil count (1.2 × 10⁹/L) and percentage (12.9%). Metagenomic next-generation sequencing (mNGS) performed on the patient’s bronchoalveolar lavage fluid detected 446 sequences of Paragonimus heterotremus. Eggs were identified upon microscopic examination of the patient’s sputum, leading to a definitive diagnosis of pulmonary P. heterotremus infection. The patient was treated with praziquantel (orally, 1 g per dose, three times daily for three consecutive days) as an antiparasitic therapy, along with cough-relieving and expectorant care. Her cough symptoms significantly improved compared to before, and follow-up examination revealed a reduction in the eosinophil percentage to 3.4%. Reports of P. heterotremus infection are rare in China. This case suggests that medical personnel should consider the possibility of parasitic diseases such as paragonimiasis when encountering patients with chronic cough that does not respond to conventional treatment.