Strongyloides stercoralis is an intestinal parasite in humans. Infected patients may be asymptomatic or have mild to moderate abdominal symptoms. It may spread to the lungs and, finally, disseminate in the immunocompromised patient. S. stercoralis is an important cause of severe pulmonary infection and death in many areas of the world. Here we describe an 87-year-old man with S. stercoralis pulmonary hyperinfection. He had respiratory failure with severe abdominal distention. Chest x-ray showed infiltration over the right upper lung field. Papanicolaou stain of sputum demonstrated the rabditiform larvae of S. stercoralis. Stool examination revealed S. stercoralis larvae and eggs. He received two courses of albendazole treatment, but died 5 weeks after admission from Gram-negative bacteremia. This case is a classic presentation of the S. stercoralis pulmonary hyperinfection syndrome.