Strongyloides stercoralis infects at least 100 million humans worldwide each year, but its prevalence is underestimated. It is endemic in hot and humid climates as well as resource poor countries with inadequate sanitary conditions. The rise of international travel and immigration has a positive impact in strongyloidiasis. Due to its unique auto infection life-cycle, Strongyloides may lead to chronic infections remaining undetected for decades. Strongyloidiasis is most often asymptomatic but it has a wide range of clinical presentations. The two most severe forms of strongyloidiasis are hyperinfection and disseminated syndromes. These occur most often in patients with impaired cell mediated immunity. A 42-year-old immunocompetent man presented with chronic watery diarrhea, malaise, upper abdominal pain, anorexia and weight lost. Strongyloides stercoralis was identified in stool samples and duodenal biopsy. The patient was successfully treated with albendazole. The authors report a case of strongyloidiasis hyperinfection in an immunocompetent host 20 years away from an endemic area and make a literature review.