It is well known that organ transplant recipients are susceptible to a host of atypical infections. Enterococcus faecium is an opportunistic nosocomial pathogen, spreading of which gained momentum in the last decade in hospitals worldwide. Infection by E. faecium, especially by strains resistant to vancomycin, carries a poor prognosis also after organ transplantation [1, 2]. However, pulmonary infections caused by enterococci are distinctly unusual. Herein, we report a 29-year-old male patient, who underwent his first kidney transplantation after waiting for 5 years on hemodialysis. His principal kidney disease was Goodpasture's syndrome. The surgery was uneventful and initial immunosupression consisted of tacrolimus, mycofenolate mofetil and steroids. Because of graft nonfunction, a core biopsy was performed on the fifth postoperative day showing acute cellular rejection grade IIB (Banff-’97). The patient received a course of antithymocyte globulin (Thymoglobulin, total dose of 800 mg; Sangstat-lmtix, Lyon, France). On the 22nd postoperative day, the patient developed acute abdomen, caused by chemical peritonitis due to a necrosis of the mid-portion of the ureter. After a nephrostomy drainage was placed, the kidney graft started functioning promptly, with serum creatinine dropping to 150 μmol/l. The course was further complicated by sepsis with multiple pulmonary infiltrates on the 31st postoperative day. Enterococcus faecium was found in the blood cultures. Intravenous lines were changed and chest X-ray examination was performed. A subsequent CT scan (Fig. 1) further specified the pulmonary lesions as abscesses, segmental pulmonary embolism and pericardial effusion were additional findings. Bronchoalveolar lavage revealed E. faecium as a single pathogen with the same sensitivity pattern. Our patient was initially treated by teicoplanin and after 3 days switched to linezolide according to strain sensitivity. Chest X-ray and CT scan showing multiple pulmonary infiltrates. Pericardial effusion as a side finding. The patient had rapidly recovered and received a course of linezolide for the next 3 weeks. The lung abscesses resolved within 21 days in the chest X-ray examination and control CT scan. The patient was discharged on the 52nd postoperative day with excellent kidney graft function (S-creatinine 87 μmol/l). His further course was complicated by recurrent episodes of kidney graft pyelonephritis caused by Klebsiela pneumoniae which subsided only after the implantation of the renal pelvis of his native kidney to the graft, thus restoring natural way of urinary drainage. One year later, the patient was found to be active with a stable graft function (S-creatinine 160 μmol/l). To our knowledge, this is the first report on E. faecium causing pulmonary infection (abscesses) as a single pathogen since a mixture of pulmonary pathogens including E. faecium has been documented so far [3]. Undoubtedly, both profound immunosupression with antithymocyte globulin and urinary leak contributed to this condition in our patient. This case may serve as a reminder that very unusual pathogens or unusual disease presentations can occur in organ transplant recipients under the intense immunosuppression.