We report a case of a 75-year-old female with renal cell carcinoma (RCC) concomitant with an arteriovenous malformation. The clinical presentation and computed tomography examination were initially interpreted as being consistent with an abscess in the left kidney. Although RCC may appear as a renal abscess in both imaging and clinical presentation, we suggest that the refractory clinical condition and evidence of arteriovenous malformation, when present, may lead to the correct diagnosis and appropriate treatment for patients with an abscess-like RCC.