Usually malignant pleural mesothelioma causes pain and dyspnoea due to local invasion of the chest wall and compression of the lung. Distant metastases rarely cause symptoms. We report on a patient with an epithelial subtype of malignant pleural mesothelioma who presented himself after chemo- and immunotherapy with shortness of breath and loss of weight due to a temporo-mandibular joint and a new nodular shadow in the contralateral lung. The prior diagnosis of an epithelial subtype of pleural mesothelioma was confirmed histologically in a pleural biopsy as well as in the resected orofacial metastases.