Toxic shock syndrome is a toxin mediated multisysyem disease precipitated by infection with staphylococcus aureus or either group A streptococcus. It commonly occurs in women who use tampons. It is characterised by a rapid onset of high fever, hypotension, rash, myalgia and vomiting. Mortality is high. Quick recognition of the syndrome is important for enabling appropriate and prompt treatment. Patients who do recover from the syndrome are at a risk of developing recurrent episodes. It must be differentiated from cellulitis, gas gangrene, pneumonia, septic shock etc.