Prevalence of inflammatory bowel disease (IBD) post-transplant is affected by the immune tolerance and modality of immunosuppression used. Mycophenolate mofetil (MMF) may have a promoting effect in developing post-transplant IBD, Crohn’s diseaselike pattern, in spite that MMF is reported to be a reasonable alternative in treating Crohn’s disease for patients who do not tolerate azathioprine. A 39 years old Omani gentleman had chronic renal failure due to advanced nephrosclerosis. He was on hemodialysis for 9 months till he received live unrelated renal transplant. He was on prednisolone, MMF and tacrolimus which is changed to sirolimus when he developed diabetes mellitus two months post-transplant. Five months post-transplant, he developed recurrent attacks of bloody diarrhea and ischiorectal abscesses complicated by anal fistulae not responding to routine surgical treatment (incision and drainage); when he was on prednisolone 10mg/day, MMF 500mg twice/day, and sirolimus 4mg/d with trouph level 7.6ng/dl. Colonoscopy showed multiple erythematous lesions in the rectum and sigmoid colon with aphthous ulcers and erosions. There was mild chronic lymphoplasmacytic cell infiltration of the lamina propria with cryptitis and noncaseating granulomatous lesions. There was no evidence of acid fast bacilli or viral infections and CMV antigenemia was negative. He was diagnosed to have IBD, Crohn’s disease-like pattern. He was treated with steroids and 5-aminosalicylic acid (5-ASA) in addition to a two months course of ciprofloxacin and metronidazole. He was continued on the same doses of MMF and sirolimus. He became asymptomatic and rectal lesions healed within one month of treatment. Six months later, he was asymptomatic and maintained on the same immunosuppressive treatment and 5-ASA with normal graft function. IBD disease can develop in renal transplant recipients in spite of immunosuppressive therapy especially when MMF is used which can be successfully treated without discontinuing this important immunosuppressive drug.