Graft rejection is usually mediated by T cells. Cellular rejection with predominant plasma cell infiltrates is rare but associated with poor prognosis.35 year old male underwent live unrelated kidney transplantation 3 years ago in Egypt with basal Serum Creatinine (S.Cr) of 160 µmol/l.7 months post -transplantation he developed gradual deterioration of his renal function with S.Cr. of 250 µmol/l. Graft biopsy was performed and showed plasma cell predominant inflammatory infiltration without evidence of vascular rejection or viral inclusions. The Immunohistochemistry studies excluded possibility of post-transplant lymphoproliferative disorder (PTLD) and staining was negative for cytomegalovirus (CMV) and Epstein-Barr virus (EBV). Polyoma virus (BKV/JCV) were not detected in the biopsy. Diagnosis of Plasma Cell-rich Acute Rejection (PCAR) Banff type 1A was made, Methyleprdnisolone 250mg IV bolus was given for three days. His immunosuppression was switched from Cyclosporine (CyA) to Tacrolimus (FK506) to achieve target level between (7-10 ug/dl). Patient was discharged with S.Cr. of 186 umol/l. He has remained stable with no further episodes of acute rejection; his last SCr. was 163 µmol/l thirty months diagnosis of PCAR. PCAR is usually associated with poor outcomes. The early diagnosis of PCAR and immediate establishment of treatment especially switching immunosuppression, might help to overcome this problem.