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Strongyloidiasis, due to infection with the nematode <i>Strongyloides stercoralis</i>, affects millions of people in the tropics and subtropics. <i>Strongyloides</i> has a unique auto-infective lifecycle such that it can persist in the human host for decades. In immunosuppressed patients, especially those on corticosteroids, potentially fatal disseminated strongyloidiasis can occur, often with concurrent secondary infections. Herein, we present two immunocompromised patients with severe strongyloidiasis who presented with pneumonia, hemoptysis, and sepsis. Both patients were immigrants from developing countries and had received prolonged courses of corticosteroids prior to admission. Patient 1 also presented with a diffuse abdominal rash; a skin biopsy showed multiple intradermal <i>Strongyloides</i> larvae. Patient 1 had concurrent pneumonic nocardiosis and bacteremia with <i>Klebsiella pneumoniae</i> and <i>Enterococcus faecalis.</i> Patient 2 had concurrent <i>Aspergillus</i> and <i>Candida</i> pneumonia and developed an <i>Aerococcus</i> meningitis. Both patients had negative serologic tests for <i>Strongyloides</i>; patient 2 manifested intermittent eosinophilia. In both patients, the diagnosis was afforded by bronchoscopy with lavage. The patients were successfully treated with broad-spectrum antibiotics and ivermectin. Patient 1 also received albendazole. Strongyloidiasis should be considered in the differential diagnosis of hemoptysis in immunocompromised patients with possible prior exposure to <i>S. stercoralis</i>.