Tehran University of Medical Sciences Iranian Journal of Parasitology 1735-7020 20 1 2025 02 27 148 152 EN Saghi Rashidifar Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran Mohammad Gharavi Department of Parasitology, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran Naser Harzandi Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran Zohreh Momeni Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran Malihe Hasan Nezhad Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2024 11 02 2025 02 27 Cryptosporidium species are a significant cause of persistent untreatable diarrhea in HIV-positive patients, especially in developing countries; however, extra-intestinal instances are rarely documented. Herein, we present three cases of pulmonary cryptosporidiosis in HIV patients at Imam Khomeini Hospital, Tehran, Iran. Despite the combination treatment with antiretroviral therapy, azithromycin, and paromomycin, the death of all 3 patients occurred due to severe complications. These cases highlight the importance of early diagnosis and management of respiratory cryptosporidiosis in HIV patients with low CD4 counts. https://ijpa.tums.ac.ir/index.php/ijpa/article/view/4420 https://ijpa.tums.ac.ir/index.php/ijpa/article/download/4420/1418