Multiple myeloma presenting as a pleural effusion

Malignant pleural effusions due to multiple myeloma are rare and it is very unusual for patients with myeloma to present with a pleural effusion. We report a sixty seven year old female who presented with a right-sided pleural effusion, which on cytological examination was found to have plasma cells. Serum protein electrophoresis demonstrated a monoclonal band and bone marrow biopsy revealed 30% plasma cells. Clinical examination and extensive investigations did not show any other causes for the pleural effusion. The patient was treated with melphalan, prednisolone and repeated thoracocentasis. She was discharged with minimal pleural effusion and was followed up in haematology and oncology clinics.