Three days after laminectomy, toxic shock syndrome (TSS) presented as acute diarrhea, rash, and fever in a 62-year-old postmenopausal woman. Forty-eight hours later, the full syndrome of TSS developed. Exploration of a benign-appearing wound revealed an occult Staphylococcus aureus infection. This report and literature review underscore the need to consider TSS in the differential diagnosis of acute diarrhea regardless of age, sex, race, and menstrual status, particularly when there has been recent soft tissue infection, injury, or surgery of any type.