A 68-year-old woman with liver cirrhosis was admitted to our hospital with high-grade fever and dyspnea on exertion in August 2007. Chest computed tomography showed right pneumothorax and consolidation with cavitation in the right upper lobe. After the chest tube insertion, yellowish purulent pleural effusion was obtained. Laboratory findings of right pleural effusion showed a high level of adenosine deaminase (101 IU/L) and a low glucose level (19.0 mg/dl) with positive smear with positive smear results of acid-fast bacilli. Mycobacterium abscessus was then confirmed by cultivation of both sputum and right pleural effusion. Her clinical symptoms and radiological findings were improved by the combination therapy with clarithromycin, amikacin, and imipenem/cilastatin for 6 months followed by combined oral treatment with clarithromycin, panipenem, and levofloxacin. To our knowledge, this is the first reported case in Japan of successfully treated empyema thoracis caused by Mycobacterium abscessus.