A 47-year-old white woman with a history of left-single lung transplant for idiopathic pulmonary fibrosis two years prior was admitted to the hospital with progressive dyspnea. Her postoperative course was complicated by repeated episodes of resistant acute rejection associated with aspiration. She also developed early-onset bronchiolitis obliterans syndrome (BOS) with bronchiectasis. At the time of admission, the patient’s symptoms were ascribed to worsening BOS. She had intermittent fevers, easy fatigability, and malaise, but denied having worsening edema, palpitations, skin changes, muscle weakness, chest pain, or arthritic symptoms.