A 51-year-old male patient with living, unrelated kidney transplantation in Iran in June 2001, developed Plasmodium falciparum P. falciparum infection. He was maintained on cyclosporine A, mycophenolate mofetil, and prednisone. In August 2005, he was admitted to a medical facility in the local community with upper gastrointestinal bleeding, and received several units of blood and blood products. Two months later, he was referred to Dhahran Health Center, and admitted with fever, abdominal pain, dysuria, and severe fatigue. Plasmodium falciparum with a parasitemia of 70% was detected in the peripheral smear. He was treated with intravenous quinidine gluconate and oral doxycycline, in addition to blood transfusion, and he responded well to the treatment. An investigation was carried out to try to find the source of malaria infection, which is believed to be the blood or blood products that he received during his initial acute illness. Measures to minimize transfusion related malaria are discussed.