A 34-year-old lady presented with acute allograft dysfunction four years after renal transplant. She had stopped her immunosuppression five months prior to presentation. Biopsy of the transplanted kidney showed acute cellular rejection and a leiomyoma was reported as an incidental finding. Allograft dysfunction was attributed to rejection, that was treated with pulse dose of steroids and anti-thymocyte globulin after which renal function improved significantly. New immunosuppression regimen with Sirolimus, Mycophenolate and corticosteroid was started, and calcineurin inhibitor was excluded. Close follow up with periodic Epstein Barr Virus (EBV) testing and allograft ultrasound were planned to monitor the progression of the leiomyoma.