Strongyloides stercoralis is a small intestinal nematode that has the ability to multiply within the human host. Because of the potential opportunistic behavior of this parasite, immunocompromised patients may develop fatal disseminated infections. Chronic strongyloidiasis may last decades and give rise to various dermatologic lesions, the most characteristic of which is larva currens, a serpiginous creeping urticarial eruption caused by the intradermal migration of the infective filariform larvae. Rarely recognized is the presence of widespread petechiae and purpura that may develop in patients with disseminated infections. A 64-year-old immunosuppressed man developed fatal extraintestinal S stercoralis infection with extensive purpura associated with massive invasion of the skin by migrating larvae.