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Omental cake is a term to describe peritoneal thickening caused by different processes. Metastatic malignancy is the most common cause. Plasma cell leukemia is a rare hematological malignancy involving plasma cells and differ from multiple myeloma in its aggressiveness, initial presentation, and dismal prognosis. Herein, we reported a case of primary plasma cell leukemia initially presented with diffuse omental cake and ascites and subsequent systemic capillary leak syndrome.