We report a case of 45 years old lady who presented with respiratory symptoms of breathlessness and chest pain of 15 days duration.  On evaluation, she was found to have left sided exudative pleural effusion with lymphocytosis and low ADA level. Malignant cells were not found in the pleural fluid on 3 occasions. She was put on anti–tubercular treatment elsewhere on the presumptive diagnosis of tubercular effusion. However, her serum LDH: pleural fluid ADA ratio was > 20 which pointed to the possibility of malignant effusion. Further computed tomography of abdomen showed diffuse thickening of the colon up to the sigmoid colon with fistulous tract between the spleen and splenic flexure of the colon with sub–capsular collection in the spleen. Multiple air fluid levels were found with collection below the left dome of the diaphragm. This raised the suspicion of colonic malignancy. Subsequently, colonoscopy and biopsy revealed well–differentiated adenocarcinoma of distal transverse colon (splenic flexure). This case highlights the atypical presentation of colonic carcinoma and need for detailed evaluation in cases where the diagnosis is not apparent.