Strongyloidosis, an important helminthic infection caused by strongyloides stercoralis, is usually seen in tropical regions and southeast US. It commonly involves small intestine however gastric involvement is possible in immunosuppressed patients. Immunosuppression, iatrogenic or otherwise may worsen the outcome by disseminating the mild or asymptomatic strongyloidosis. 68 year old Hispanic male with 4 months history of nausea, vomiting, abdominal bloating and weight loss presented with dehydration and diffuse abdominal pain. Three months ago, he was diagnosed with eosinophilic gastritis by EGD and was being actively treated with prednisone without improvement. Two weeks prior to the admission, he developed culture-negative meningitis and was treated with IV antibiotics. Upon admission he complained of early satiety, mild cough and wheezing. He denied diarrhea, dyspnea, hemoptysis, skin rash or seizures. Physical examination was normal except mild epigastric tenderness. Initial investigations revealed hyponatremia, normal WBC count, hemoglobin and eosinophilia (6%). Stool specimens failed to show ova or parasites. Chest × ray and abdominal films were normal. Repeat EGD revealed friable gastric and duodenal mucosa. Biopsies revealed multiple adult strongyloides, larvae and eggs at various stages of development. Strongyloides IgG was positive at 1.45 (normal <1). Serum was non reactive for HIV, HTLV1 and II. He was treated with ivermectin and steroids were tapered off with significant improvement in symptoms and resolution of eosinophilia. In this patient, steroids facilitated the dissemination of infection as manifested by the intensification of gastrointestinal symptoms, mild pulmonary symptoms and meningitis that likely resulted from the bacteremia originating from GI tract. Prompt recognition, treatment and withdrawal of steroids resulted in uneventful recovery. Additionally peripheral eosinophilia was seen that is typically absent in eosinophilic gastritis. As emphasized in our case, it is important to exclude parasitic infections in high-risk patients with vague gastrointestinal symptoms and eosinophilia, especially before starting immunosuppressive agents. [figure 1]Figure