Purpose: A 60-year-old African American male patient living in upstate New York presented with a several day history of rectal bleeding and left lower quadrant pain. His previous medical history included diabetes, hypertension and hyperlipidemia, and he had no significant family medical history. He denied fevers, chills, diarrhea, nausea, vomiting, or weight loss. He was a non-smoker, did not use any antiplatelet agents, and had no history of previous rectal bleeding. He had normal CBC, comprehensive metabolic profile, and coagulation profile. He underwent a colonoscopy for further characterization of his bleeding; and it was notable for small non-bleeding internal hemorrhoids and a dozen small white punctate lesions in the descending colon. Biopsies of the lesions revealed active eosinophilic colitis with microabscesses and helminth fragments. On further review of the patient's social history, he was originally noted to be from Jamaica, having moved to the United States in 1995. Out patient underwent subsequent stool examinations, which returned negative for any pathogens. Serum Strongyloides IgG and IgM levels were obtained though the state laboratory, and were consistent with active infection. The patient was treated with high dose ivermectin therapy, and remains asymptomatic. Strongyloides stercoralis is an endemic parasitosis that results from infection with a female nematode, with the highest prevalence in the tropical and sub-tropical regions, as well the southeastern United States. Many findings of strongyloides infections of the large bowel have been described, ranging from severe colitis to small ulcers. Diagnosis requires high clinical suspicion, careful history taking, and tissue histopathology, especially as many previously reported cases in the literature describe patients without peripheral eosinophilia. Endoscopic findings and descriptions of Strongyloides infections have only appeared more recently with the advent of endoscopic procedures. Endoscopic descriptions have typically been consistent with moderate to severe colitis, as these patients present more often to the hospital. Patients have been described with and without immunocompromised states and can present with various clinical syndromes. Those with underlying immunocompromised states, are at significantly higher risk, and can present with systemic disease that can mimic sepsis. Our case demonstrates that Strongyloides can manifest itself as punctuate lesions and that this is the first reported case to our knowledge of such a presentation. The diagnosis of Strongyloides should be considered in any patient presenting with gastrointestinal symptoms, tissue eosinophilia, and previous exposure to endemic areas.