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Toxic shock syndrome (TSS) caused by group A Streptococcus is uncommon but associated with high mortality. In this case report, a 17-year-old girl with influenza A presented with a rash, hypotension, parapneumonic effusion and multiorgan failure. Group A streptococci were identified in the pleural fluid. This case highlights the importance of early recognition of TSS, since treatment with clindamycin and immunoglobulin may improve the prognosis. As rates of meningococcal disease have decreased, TSS likely causes an increasing proportion of cases of septic shock among children in Denmark.