We suggest that the Salzachtal-Ennstal-Mariazell-Puchberg (SEMP) fault, a major strike-slip system in the European Alps, is active. It has accommodated lateral extrusion of the central part of the Eastern Alps toward the Pannonian Basin. The main tectonic activity of this fault dates back to Oligocene and Miocene time, but until now it was largely unknown whether the fault was still active. We present here the first field evidence of neotectonic activity from a cave in the Hochschwab karst massif (Styria, Austria) that intersects a segment of the SEMP fault zone. Damaged speleothems in this cave include scratched flowstone (a hitherto undescribed feature), massive flowstone disrupted by a fault, and ruptured flowstone. The superposition of younger flowstone layers allows constraining the time frame of the tectonic events using U/Th dating. The youngest flowstone of the pre-damage generation is ca. 118 ka (end of the Last Interglacial) and the oldest post-event layer is ca. 9 ka (early Holocene). The tectonic event bracketed by these layers coincided with a growth hiatus during the last glacial period, consistent with the high alpine setting of the cave. Geologic evidence precludes deformation mechanisms other than tectonic. These new data are consistent with vectors of continuous global positioning system measurements as well as instrumental seismicity data, and collectively suggest that the SEMP is an active fault and that lateral extrusion of the Eastern Alps is ongoing.