A 62-year-old male with a 30-pack-year smoking habit was admitted to our clinic with dyspnea. A chest computed tomography (CT) scan revealed a spiculated mass with enhancement in the left upper lobe (LUL; Fig. 1A) and concurrent multiple pulmonary nodules (Fig. 1B). 2-Deoxy-2-[18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT demonstrated FDG avidity in LUL nodule (Fig. 1C). The patient underwent thoracoscopic wedge resection of LUL nodule and histopathology revealed a chronic granulomatous inflammation associated with several yellow-brown and ovoid eggs with a thick shell, all of which were characteristic attributes of pulmonary Paragonimus westermani infection (Fig. 2A). The patient did not reveal any special diet containing raw or undercooked fish. Blood P. westermani antibodies were positive and serum total Ig-E level was elevated up to 1,663.1 UI/mL. Based on these findings, the patient was treated with praziquantel. At the same time, 1.9 cm FDG-avid lesion in left submandibular gland was detected during the work-up. However, further evaluation on the lesion was impossible owing to patient’s refusal. Five months after treatment, follow-up high-resolution computed tomography (HRCT) images showed increased size of remnant pulmonary nodules (Fig. 2B) and in follow-up FDG-PET/CT scan, some nodules had augmented metabolism (Fig. 2C). Wedge resection of remaining FDG-avid nodules in the superior lingular segment revealed that it was poorly differentiated metastatic carcinoma which had a hyperchromatic and pleomorphic nuclei (Fig. 2D). Results from PET/CT scans demonstrated increased FDG avidity in the submandibular gland, suggesting presence of primary malignancy in this area (Fig. 2E). Finally, excisional biopsy of the submandibular gland confirmed carcinoma ex pleomorphic adenoma which appeared as pleomorphic tumor cell infiltrating into the benign adenoma (Fig. 2F). Herein, we demonstrated an extremely rare case of metastatic lung cancer originating from salivary gland concurrent with parasitic lung infection. Even though paragonimiasis has been frequently reported to mimic primary lung cancer [1–3], the possibility for the coexistence of paragonimiasis with malignant lung lesion from various origins should not be overlooked in clinical practice.