Multiple myeloma is a malignant proliferation of plasma cells, predominantly involving the bone marrow and skeletal system. Pleural effusions are rarely associated with multiple myeloma and most often signify a concurrent disease process, e.g. amyloidosis.(1,2) Malignant myelomatous pleural effusions are even more unusual, occurring in less than 1% of cases of multiple myeloma.(1) Here we report the case of a patient with multiple myeloma presenting with a myelomatous pleural effusion at disease recurrence.