Streptococcal Toxic Shock Syndrome (STSS) is one of reemerging infectious diseases, most common sources of which are skin and throat. In this report, we present a case of decompensated STSS originated from unusual clinical situation. A 31-year-old previously healthy nongravid woman presented with acute onset, diffuse abdominal pain:she was diagnosed with acute panperitonitis and acute salpingitis. Culture from the peritoneal cavity was positive for Streptococcus pyogenes. Clinical and laboratory finding not the criteria of STSS:hepatic injury, acute renal failure, acute respiratory distress syndrome, disseminated intravascular coagulopathy, desquamative rash with bullae, and soft tissue necrosis. Hemodynamic shock was managed with fluid and inotropics. Initial broad-spectrum antibiotics were changed to combination therapy of intravenous penicillin G and clindamycin after diagnosing of STSS. Gamma globulin was administered intravenously. Acute hypoxemic respiratory failure was managed with mechanical ventilation. The patient died of multi-organ dysfunction syndrome ten days after the disease onset. Because STSS may be one of the reemerging infectious diseases with grave illness and have different clinical course in contrast to septic shock, earlier confirmative diagnosis and constitution of proper antibiotic therapy are mandatory for better outcome.