Streptococcal toxic shock like syndrome is a rapidly progressive and a fatal disease like staphylococcal toxic shock syndrome. In spite of the wide expansion and development of potent antibiotics, streptococcal infection still threatens human being. Recently we experienced a patient with toxic shock like syndrome who was suffered from fever and neck pain with rapid progression to hypotension and multiorgan failure. Streptococcus pyogenes was proven in his throat culture which was done on admission. Pleural effusion and suspicious carditis with aortic and mitral valve regurgitation were examined on the third hospital day. He was treated successfully with antibiotics but we wanted to emphasize potentially fatal streptococcal toxic shock like syndrome in pediatric patients.