The patient was a 76-year-old woman, who had been receiving on maintenance hemodialysis therapy since May 1992 due to stage5 chronic kidney disease caused by chronic glomerulonephritis. In June 2008, she was diagnosed as having multiple myeloma (IgA-λ type). In August 2009, she was started on MP therapy (melphalan and prednisolone). MP therapy effectively induced a decrease in serum IgA, and there were no adverse reactions. A second cycle of MP therapy was started 5 weeks after the first cycle, and thalidomide was introduced at 100mg/day. In October 2009, the patient was referred to our hospital for determination of the cause of hypotension during hemodialysis. On admission, physical examination demonstrated dyspnea, marked edema of the right lower leg, and hematologic examination demonstrated abnormally high plasma FDP and D-dimer levels. Contrast-enhanced CT of the chest and pulmonary arteriography demonstrated contrast defects suggestive of embolism of the left main pulmonary artery, and a diagnosis of deep vein thrombosis of the leg with pulmonary embolism was made. Heparin infusion was started, along with placement of an inferior vena cava filter, which resulted in improvement of both the deep vein thrombosis of the leg and the pulmonary embolism. Thalidomide, which shows efficacy against multiple myeloma, has been reported to cause pulmonary embolism as an adverse reaction. The usual dosage of thalidomide is 100 to 400mg/day, and our patient developed pulmonary embolism despite receiving the lowest recommended dose level of 100mg/day. We consider this case not able as it suggests that thalidomide, given for the treatment of multiple myeloma, may trigger the development of pulmonary embolism even when administered at low doses in patients under maintenance hemodialysis therapy.