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IntroductionPurpura fulminans (PF) was first described in 18861 and is characterized as a rare syndrome with a rapidly progressive course of hemorrhagic infarction of the skin and soft tissue necrosis. It mainly occurs in children and rarely in adults.1 PF is a life-threatening disease that can be a clinical presentation of toxic shock syndrome (TSS).2 The most common infectious etiology is cocci, and routine use of antibiotics for this disease is well recognized. However, another etiology, influenza virus, is often neglected. We herein report a case involving an older patient with TSS presenting with PF, in which Streptococcus pyogenes (S. pyogenes) accompanied by influenza virus might have played an important role, in order to arise the attention of clinician to the infection of the influenza virus in the pathogenesis of TSS.