We describe the first case report of an Adult Onset Still’s Disease (AOSD) in a previously healthy young man from Jazan, Saudi Arabia in the summer of 2017. The patient symptoms, signs and investigations fulfilled Yamaguchi’s criteria for the diagnosis of Adult Onset Still’s disease [1]. The patient experienced a sore throat, high grade fever, right knee arthralgia, left knee arthritis, a generalized salmon colored rash, leukocytosis, elevation of liver transaminases, high LDH, high ferritin, absence of ANA, RF, AMA, ASMA and DNA and reactive bone marrow aspiration and biopsy without any evidence of infectious diseases etiologies or malignancies that were satisfactory to confirm the diagnosis of AOSD. We have observed an evidence of two different bacterial sources simultaneously as triggering etiologies; positive ASO titer and positive blood culture for E. Coli where the clinical features and laboratories investigations derangement post antibiotics treatment have remained. The patient has responded to the pulse methylprednisolone and tapering doses of prednisolone. Our successful clinical experience in the case is that the prednisolone lower doses combined with NSAID (voltaren) to minimizing the steroid adverse effects was sufficiently effective to maintaining remission.