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A male patient presented with a signs and symptoms of a respiratory tract infection associated with a pleural effusion. The effusion had negative cytological analysis and a CT scan showed mild pleural thickening. The effusion resolved completely on chest radiographs and the patient was discharged from the respiratory service, but the effusion recurred. After further investigations and elucidating significant asbestos exposure in the medical history, mesothelioma was eventually diagnosed. The patient is currently receiving chemotherapy with palliative intent. This paper highlights the importance of ongoing follow-up in a patient with a label of benign asbestos-related pleural effusion.