Post-transplant cytomegalovirus (CMV) infection has long been known as the “troll of transplantation”—a hidden threat that can emerge after solid organ transplant (SOT) or hematopoietic cell transplant (HCT) and jeopardize patient well-being. CMV infection is associated with increased morbidity, mortality, graft loss, and hospitalization, as well as a substantial patient burden that many clinicians may underappreciate. Management becomes even more challenging when infection is refractory or resistant to treatment. To improve outcomes, healthcare professionals must be able to identify patients at risk for CMV infection and refractory/resistant disease, interpret diagnostic findings, apply updated guideline recommendations, and individualize antiviral therapy using current evidence. This comic-based, expert-led case activity follows a transplant recipient from the initial presentation of CMV infection through refractory/resistant disease, with patient perspectives woven throughout. Expert faculty perspectives and patient commentary will explore the clinical and psychosocial burden of CMV infection, risk assessment, diagnosis, treatment selection, resistance testing, and shared decision-making in posttransplant CMV care.