A 37 year male from village came to medicine OPD with the complaints of hemoptysis, abdominal pain , fever , weight loss and persistent diarrhea since 20 days. On further investigations patient came to be a known case of HIV since 8 years with current CD4 counts being 48 cells/micro litre. He started receiving ART 5 months back. The patient was given symptomatic treatment and was discharged. After 3 days patient was readmitted with severe vomiting and died immediately on admission. Post–mortem showed small bowel mucosal edema and plenty of strongyloides stercoralis larvae with transmural migration.