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We present a 33-year-old patient, born in Sri Lanka and living in Switzerland for 12 years, who complained of acute pain in the right shoulder and the right upper abdomen. Rest and symptomatic therapy produced transient improvement, but pain – even more severe – recurred 10 weeks later. A 9 x 5 cm hypodense subdiaphragmatic lesion in the right hepatic lobe was seen on a CT scan. The diagnosis of amoebic liver abscess was established on the grounds of positive serology for antibodies to amoebae, and therapy with metronidazole was initiated. Percutaneous aspiration of the liver abscess was not successful because of the abscess rupture in the pleural space. Pleural drainage produced prompt improvement in the clinical status, and the patient was discharged home 8 days later.