TSS was originally attributed to super-absorbent tampon use but can be associated with isolation of group A Streptococcus (GAS) from any sterile or nonsterile body site. Patients with TSS typically exhibit hypotension or orthostasis, a temperature >102°F, a diffuse macular erythroderma that involves the palms and soles and desquamates 1–2 weeks after the onset of illness, and evidence of multiple organ system dysfunction including (at least three): vomiting/diarrhea, myalgia, hepatitis, disorientation, mucosal inflammation, thrombocytopenia, and twofold increase in BUN/Cr. Clinically significant bleeding diatheses are uncommon in TSS, although thrombocytopenia, elevated PT, PTT, and FSP may be present. The case definition for TSS does not require a positive culture for GAS. However, patients should have serologic tests to exclude other diseases such as RMSF, leptospirosis, measles, HBV, VDRL, and infectious mononucleosis.