Influenza may pave the way for some specific bacterial infections. In this case study we present a rare complication of influenza A infection – periorbital cellulitis followed by streptococcal toxic shock syndrome and scarlet fever. A 4-year-old otherwise healthy girl presented with her mother to a general practitioner with fatigue, irritability and fever not responding to antipyretics. Due to the positive rapid influenza diagnostic test, treatment with oseltamivir was implemented. The Quick Strep Test was negative. During the following days, the patient’s condition worsened, leading to an admission to a paediatric otolaryngology unit. Doctors observed an asymmetrical swelling of the lids with exophthalmos of the right eye, pharyngitis, petechiae in skin folds, a strawberry tongue and skin exfoliation on the lips. The patient was treated with intravenous broadspectrum antibiotics (cefotaxime, vancomycin) and underwent drainage of sinuses, without any significant improvement. On the following day, the girl showed signs of systemic infection, confusion and further swelling of both eyes, and therefore was moved to an intensive care unit. Computed tomography of the head showed signs of periorbital cellulitis with destruction of the surrounding bones. After obtaining a positive blood culture for group A streptococcus, penicillin and clindamycin were immediately administered. The patient’s condition improved within 24 hours. The described case emphasises the importance of yearly influenza vaccination, especially in the groups with risk factors like very young age. Early diagnosis of the streptococcal infection as a complication of influenza and a targeted treatment may prevent the potentially fatal outcome in the form of streptococcal toxic shock syndrome.