A 22-year-old male received a bilateral lung transplant for cystic fibrosis and had an essentially uncomplicated post-transplantation course for 26 months (with the exception of a Grade A2 rejection episode at 12.5 months post-transplant). He developed worsening cough, increasing fatigue, and dyspnoea following exposure to his spouse who had developed upper respiratory tract infection symptoms. Spirometry showed a significant decline in FEV1, and oxyhaemoglobin desaturation was noted. TBB revealed changes of AFOP and was also graded as showing a Grade A1B1 acute rejection, and BAL cultured MSSA at 2 x 104 colony forming units (cfu)/microl but was negative for respiratory viruses. The patient's symptoms initially improved with antibiotics and pulse methylprednisolone, but FEV1 subsequently progressively declined and the patient eventually succumbed to respiratory insufficiency.