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Introduction: Multiple myeloma represents a malignant disorder of plasma cells. Extramedullary relapse in multiple myeloma is a rare occurrence, and pericardial involvement stands as an exceedingly uncommon manifestation. Only a few documented cases of pericardial effusion as an extramedullary relapse presentation of myeloma exist. Bispecific antibodies are emerging as a novel class of immunotherapy drugs for the treatment of relapsed refractory multiple myeloma patients who have experienced failure with four prior lines of therapy. According to a literature review, none of the reported cases with pericardial effusion relapsed myeloma have been treated with bispecific antibodies, given that these drugs have only recently gained approval. Case Presentation: We present a rare case of a patient with pericardial effusion resulting from myeloma relapse, treated with teclistamab, a bispecific antibody, and achieving an excellent response. Conclusion: Bispecific antibodies, such as teclistamab, show great effectiveness as a treatment for patients with relapsed refractory multiple myeloma, including those with extramedullary disease.