A case of clinically severe trichinosis following ingestion of commercially prepared pickled pigs' feet is reported. An unusual finding on muscle biopsy was a larval count of 4,046 per gram of muscle, the second highest density of muscle invasion recorded to date. Survival has not been reported previously in patients with greater than 1,000 trichinae per gram of muscle. Complete symptomatic recovery followed combined corticosteroid and thiabendazole administration.