Extramedullary plasmacytoma is a rare and unusual complication of multiple myeloma (MM). Some sites for the extramedullary involvement of MM are the liver, spleen, lymph node, lung, and skin. Renal failure is another complication of MM due to myeloma kidney, uric acid nephropathy, hemoconcentration, or light chain disease. This study reported a case of MM with unusual presentation. She was a 61-year-old woman who was admitted to the internal ward due to severe renal failure, anemia, mild proteinuria, hypertension, thrombocytopenia, and soft tissue mass in both lungs in the spiral computed tomography (CT) scan. In the skull X-ray, there was not any lytic lesion. Further, plasma cells greater than 30% were observed in serum protein electrophoresis pick of gamma region and in the bone marrow aspiration, so the final diagnosis of the patients was MM with extramedullary plasmacytoma.