A previously healthy 16-year-old boy suffered chest pain, shortness of breath and circulatory collapse. Investigations revealed massive bilateral pulmonary embolism, severe biventricular cardiac dysfunction, acute kidney injury, and severe systemic inflammation. He received hemodynamic support, thrombolysis, and broad-spectrum antibiotics, later VA-ECMO due to profound myocardial dysfunction. Methicillin-sensitive Staphylococcus aureus positive for lukS-PV and lukF-PV genes grew from respiratory samples and blood cultures, without detection of tst, eta and etb. Therapy was adjusted to clindamycin and linezolid as antitoxin drugs, immunoglobulins were not administered. Despite maximal care, refractory multiorgan failure developed and the patient died within 24 hours of admission to the ICU. PVL-positive S. aureus can cause sepsis with symptoms similar to toxic shock without classical toxin genes. The case highlights the diagnostic and therapeutic challenges of atypical forms of shock.