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Live <jats:italic>Strongyloides stercoralis<\/jats:italic> larvae were observed in stool samples and duodenal biopsy confirmed the presence of the parasite at multiple life cycle stages within the lamina propria. He was diagnosed with <jats:italic>Strongyloides<\/jats:italic> hyperinfection with underlying human T-cell lymphotropic virus type 1 and treated with a prolonged course of ivermectin with ongoing monitoring for relapse. 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