A 61-year-old man with septic enophthalmitis and cramps in the upper abdominal region, fever and leukocytosis was admitted to hospital. Ultrasound examination revealed an inhomogenous enlargement of the left kidney with normal conturation and swollen, in part almost transonic, renal parenchyma. In the area of the left kidney CT demonstrated an enlarged tumor with inhomogenous and destroyed structures. The left kidney was removed. Histology confirmed the diagnosis of renal parenchymal malakoplakia.