To the dear Editor,We would like to discuss the recent publication entitled “Pneumothorax induced by pulmonary paragonimiasis” [1]. The author, Kim [1], reported two interesting cases and noted that “When pneumothorax develops in patients who have ingested raw fresh-water crab or stream water, paragonimiasis should always be considered in the differential diagnosis.” In fact, Im et al. [2] noted that ‘pneumothorax or hydropneumothorax’ is the early clinical evidence of pulmonary paragonimiasis. This can include asymptomatic findings from a radiological imaging assessment [2]. However, it should be noted that the findings in other countries are different from those in Korea. Kanpittaya et al. [3] noted that “radiographic findings of pulmonary paragonimiasis may vary among countries.” Based on our findings from Thailand, pneumothorax is not commonly associated with pulmonary paragonimiasis, and it is rarely observed in the clinical and radiographic findings of the patients with this condition [4]. The explanation for the more common appearance of pneumothorax associated with pulmonary paragonimiasis in the Korean population relative to cases in other countries requires further study.