Human polyomavirus 9 (HPyV9) is a polyomavirus with up to 30% seroprevalence in solid organ transplant recipients (SOTRs). Despite its significant seroprevalence in this population, it had previously not been associated with disease. However, in 2022, sentinel literature described a hyperkeratotic papular eruption followed by pulmonary compromise, clinical decline, and death in SOTRs from HPyV9 infection. Patients were 7-13 years out from their transplants (kidneys or lung), and 2 of the 3 had a history of more than 1 transplant (3 kidney transplants in 1 patient and 2 lung transplants in another). Each patient developed an acral eruption that generalized and was followed by the development of systemic symptoms, including anorexia, weight loss, fatigue, dyspnea, and ultimate demise 4-13 months after rash onset. Acute lung injury from diffuse alveolar hemorrhage was thought to be the cause of death in the reported patients.