Two patients with severe group A streptococcal infection associated with a toxic shock-like syndrome are described. Both isolates produced the pyrogenic exotoxin B. Since 1987 there have been many reports of these severe streptococcal infections. In order to know the incidence in the Netherlands, isolates from patients with severe streptococcal infection have to be serotyped (types of M-protein) and tested for streptococcal toxin production, and serum antibody levels have to be determined.