OBJECTIVES: Pneumocystis jiroveci pneumonia is common in immunocompromised individuals. PATIENTS: This case report describes an immunosuppressed patient who acquired P jiroveci pneumonia 6 months after renal transplant surgery. RESULTS: The patient experienced many pneumonia-related complications and adverse effects from drug therapy, and despite treatment with various antibiotic agents, he died on the 62nd day after his admission to the intensive care unit. CONCLUSIONS: The therapeutic failure of the drug of choice (co-trimoxazole) was evident. This case raises questions about the development of P jiroveci resistance to current therapies.