Multiple myeloma presenting with pleural effusion as the initial manifestation is uncommon. Usually the effusion is due to non–malignant causes. Myelomatous pleural effusion is an extremely rare entity. Here, we report the case of a 70 year old man who presented with right sided pleural effusion. The diagnosis was made cytologically by abnormal plasma cells in pleural fluid and high levels of monoclonal band in both serum and pleural fluid. The patient received one cycle of treatment despite of which, he had a downhill course. We review the clinical details of this case and related literature.