Adult Onset Still Disease (AOSD) is a rare inflammatory disease. A 20-year-old male was sent to our clinic due to pleural effusion with complaints of sore throat, daily spiking fever and shortness of breath. Thoracentesis showed exudative effusion. Despite intense antibiotic treatment, the high fever continued and his clinical condition got worse. Microbiologic studies showed no nonspecific or specific pathogens in sputum, pleura and blood samples. Serum ferritin level was high and due to Yamaguchi criteria, he was diagnosed as AOSD. He was successfully treated with steroid therapy. The diagnosis and management of AOSD is a clinical troublesome because of the heterogeneous clinical presentation, absence of pathognomonic findings, markers and specific treatment. The disease rarely presents with pleural effusion. Since it is not common in respiratory medicine clinical practice, AOSD must be taken into consideration for differential diagnosis of pleural effusion and fever of unknown origin.
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