Pleural parasitic infection is an extremely rare disease of the pleura caused by a variety of parasites, with paragonimiasis infection being the most common. The lack of specific clinical symptoms for paragonimiasis makes it easy to misdiagnose as tuberculosis, causing unnecessary drug-related adverse effects and financial burdens from incorrect treatment. We report a case of a pediatric patient presenting with an isolated pleural effusion that was misdiagnosed as tuberculosis; the patient was eventually diagnosed with pleuropulmonary paragonimiasis infection after immunologic and serologic tests. The patient finally recovered after anti-parasitic treatment involving praziquantel administration. This report will help increase awareness of this disease among medical practitioners to avoid misdiagnosis and treatment delays which may lead to disease progression.