Malakoplakia is a rare chronic inflammatory process, most commonly affecting the urinary tract. This entity was first described by Michaelis and Gutman in 1902. As of 1995, only 85 cases of malakoplakia of the gastrointestinal tract has been reported. The common sites of colonic involvement are the rectum, sigmoid, and right colon, in descending order of frequency. The most common disease associated with malakoplakia is colorectal carcinoma. Surgical resection is the treatement of choice for cases associated with carcinoma or complications. But in other cases, medical treatment could be attempted. Antimicrobial drugs, such as trimethoprime-sufamethoxazole, rifampin, or as recently suggested, ciprofloxacin can be used. We report a case of rectal malakoplakia treated by ciprofloxacin with a review of literatures.