Presently talc is one of the agents most commonly used for producing a pleurodesis in patients with either a recurrent pleural effusion or a spontaneous pneumothorax. Talc can be instilled into the pleural space either as an aerosol (insufflation) or as a suspension (slurry) in saline. They are quite effective in producing a pleurodesis. However, they rarely have acute serious adverse effects including acute respiratory distress syndrome, and recently a discussion for using pleurodesis has been reported. We experienced a case of acute respiratory distressed syndrome after talc pleurodesis. A 64 year old man, who was diagnosed lung cancer with a malignant pleural effusion at the same side, was treated by pleurodesis using talc to control the effusion. After 3 days, he suffered fever, chill and breathlessness. The chest PA and CT revealed a bilateral infiltration in both lungs and the blood gas analysis confirmed hypoxemia, which required mechanical ventilation.