Pulmonary renal syndromes are classically associated with systemic vasculitis and autoimmune disorders, such as systemic lupus erythematosus and Goodpasture syndrome. The dramatic presentation of pulmonary hemorrhage in conjunction with new onset renal insufficiency as presented in this case naturally led to the search for primary pulmonary renal syndrome. Interestingly, the patient was found to have a new diagnosis of multiple myeloma presenting with symptoms of hemoptysis and acute renal failure. The constellation of pulmonary renal symptoms seen in this case is extremely rare in association with multiple myeloma; specifically, only one other case has been reported with similar presenting symptoms. This article reviews and discusses a case of pulmonary renal syndrome related to multiple myeloma. A review of the current literature of pulmonary renal syndrome in multiple myeloma is also presented.