CMV infection is the most prevalent infection occurring in renal transplant recipients (RTR) and causes considerable morbidity and mortality. As most normal adults are CMV positive, CMV infection in RTR is generally due to reactivation where either recipient and donor are CMV positive, or recipient is positive while donor is negative. Primary CMV infection in RTR is rare. We describe primary CMV infection occurring in a 55 years old male patient with long history of DM and HTN. He developed ESRF in 2001 and was managed by HD. Eighteen months later he became HCV positive and was treated with interferon alpha for 9 months with adequate response. The patient was CMV negative for both IgG and IgM. He received live unrelated renal transplant abroad in 2003 with full recovery of renal functions. He was placed on cyclosporin, mycophenolate and prednisolone in addition to acy-clovir and septran prophylaxis. Six weeks following transplantation he presented with fever, malaise, anorexia and cellulites of his right toe. The rest of the physical examination was normal. Laboratory evaluation showed leukopenia, normal renal functions and minimally impaired liver function tests. Septic work-up showed E.coli and pseudomonas aeruginosa from his toe. The patient received antibiotics for the toe infection but his fever persisted. He was retested for CMV IgM which came to be positive. Consequently, he developed dysphagia due to viral esophagitis. This was confirmed by upper gastrointestinal endoscopy where the biopsy showed esophageal ulceration of viral origin (Herpes simplex and/or CMV). At this stage he was started on gancyclovir for 3 weeks, following which he became afebrile, the dysphagia was resolved, liver function tests became normal and CMV IgG became positive. Renal transplantation in a setting of D+/R- and use of strong immunosuppressives like mycophenolate are two important risk factors for acute CMV infection in RTR. Intravenous gancyclovir is highly effective treatment for the established CMV infection. In the D+/R- setting prophylactic therapy with gancyclovir or valagancyclovir is highly indicated.