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The authors present a case of toxic shock syndrome associated with use of a vaginal contraceptive sponge in an 18-year old white nulligravid female. The patient presented with a 1-day history of vaginal discharge accompanied by fever chills nausea and severe orthostatic dizziness. The yellow-green discharge had started shortly after the painful removal of a contraceptive sponge which had been in place for 20 hours. No vaginal tampons had been used. The Centers for Disease Control had reported 4 cases of toxic shock syndrome in association with vaginal sponge use; overall there appear to be 13 confirmed cases of toxic shock syndrome with this association. The case presented in this letter differs somewhat from other cases in that the patient was younger menstruating and left the sponge in well under the recommended time of 30 hours. Although the vaginal sponge is gaining acceptance as a convenient effective contraceptive device with a low incidence of complications physicians should be alert to the possibility of toxic shock syndrome among sponge users.