Case 1: A 57-year-old man, with a 30-year history of steroid-dependent asthma, was admitted to John Sealy Hospital in Galveston, Texas, in February 1989, for an exacerbation of asthma. His past medical history was significant for a diagnosis of disseminated strongyloidiasis in 1987, hypertension, coronary artery disease (status post coronary artery bypass surgery 1986), and psoriasis. The strongyloidiasis was felt to have been adequately treated with thiabendazole at that time. Medications, prior to admission, included theophylline, metaproterenol inhaler, diltiazem, amiloride, hydrochlorthiazide, ampicillin/clavulonate, and methylprednisolone, 48 mg a day.Physical examination revealed an obese male in moderate respiratory distress. The blood pressure was 180/104 mm Hg, and the pulse was 104 beats per minute. There was conjunctival irritation of the right eye. Expiratory and inspiratory wheezes were detected on lung examination. The remaining examination was normal. Arterial blood gas in room air revealed a pH of 7.46, PCO2 of 39 mm Hg, HCO3 of 28 mEq/L, and PO2 of 77 mm Hg. Hemoglobin and hematocrit were 15.4 g/dL and 45.1%, respectively, and a platelet count was 366,000/mm^ White blood cell count was 16.5/mm^ with a differential of 97% neutrophils, 1% bands, and 2% lymphocytes. Serum electrolytes and chemistries Were normal. A chest radiograph revealed cardiomegaly and hyperinflated lung fields.The patient was treated with intravenous methylprednisolone, 125 mg every 8 hours, intravenous theophylline, and nebulized metaproterenol inhaler treatments. In spite of intensive therapy, his condition deteriorated requiring endotracheal intubation and monitoring in the intensive care unit. At that time a sputum sample isolated Strongyloides stercoralis larvae (Fig. 1). A fecal specimen examination for ova and parasites also detected the presence of Strongyloides stercoralis. Thiabendazole, 1500 mg p.o. every 12 hours, was started, and methylprednisolone was tapered. The Dermatology Service was subsequently consulted for an extensive petechial and ecchymotic eruption of the abdomen and proximal extremities. The purpura was From the