This article describes the four cases of serious infections caused by Streptococcus pyogenes in the head and neck. Three patients presented with invasive infections of the soft tissues in the neck and one with epiglottitis. Two patients fulfilled the criteria for toxic streptococcal shock syndrome. The incidence of severe streptococcal disease is increasing in Norway, which emphasizes the importance of an aggressive attitude when diagnosing and treating atypical throat infections.