INTRODUCTION: Although cholangiocarcinoma is common in Thailand, it is uncommon to present as liver abscess1. Both conditions may be difficult to differentiate by clinical, laboratory and radiological findings2. CASE DESCRIPTION/METHODS: A 61-year-old-male with underlying type-2 diabetes presented with RUQ abdominal pain with low grade fever for 1 month. Two weeks later, he developed jaundice after taking herbal medicine. He visited a nearby hospital. Abdominal CT showed a 7.5 × 8.5 cm hypodensity lesion with rim enhancing and internal septation at right lobe liver (Figure 1) with no evidence of intrahepatic or common bile duct dilatation. He was treated as liver abscess with ceftazidime and metronidazole for a week, but not improved. Hence, he was referred to our hospital. At our hospital, physical examination revealed mildly pale, markedly icteric sclerae, tender hepatomegaly, but no splenomegaly. Lab showed Hb 10.7 g/dL, WBC 11.8 × 103/mL, platelets 140 × 103/mL, PT 24.8 sec, INR 2.4, PTT 35.5 sec, serum TB/DB 12.4/ 9.2 mg/dL, AST 80, ALT 51, ALP 134 IU/L, albumin/globulin 2.5/4.2 g/dL. Hemoculture, melioidosis and amoebic serologies, HBV, HCV and HIV tests were negative. Follow-up abdominal CT found a heterogeneous hypodensity lesion, 7.5 × 9 cm in size, with rim enhancing and internal air bubble at right lobe liver (Figure 2), suggestive of liver abscess. AFP was 11 IU/mL and CA 19-9 was 183 IU/mL. Provisional diagnosis was liver abscess with jaundice suspected from herbal drug induced liver injury (DILI). On USG-guided aspiration, 30 ml purulent material was found, which was negative for gram, AFB and fungal stain, including culture and bacterial identification. Ceftazidime and metronidazole were continued for 1 week, subsequently switched to imipenem for 1 week, however his fever did not resolve. The USG-guided aspiration was performed again, which found only 2 ml of pus. Biopsy of abscess wall was done. Pathologic results showed moderately differentiated adenocarcinoma (Figure 3),positive for CK7 and negative for CK20. The definite diagnosis was intrahepatic cholangiocarcinoma. DISCUSSION: Cholangiocarcinoma may present as liver abscess secondary to biliary tract obstruction or tumor necrosis with infection. In this case, CT findings of cholangiocarcinoma mimic liver abscess and history of herbal use misleads to diagnose jaundice from DILI. Thus, malignancy should be suspected when liver abscess does not resolve after treatment with antibiotics and adequate drainage.