Rootkits
Just spent the last week removing this from various pc's and one of them also had a very nasty rootkit that was spamming like a monkey flinging poo! The biggest problem was after MBAM removed most of the initial crap, Blacklight, Rootkit Revealer, AVG Anti Rootkit and a couple of others all failed to spot the hidden mass mailer. Only after manually looking through the registry and running Gmer did the final few nasty's show up and as Gmer scanned an old version of Norton was able to quarantine them. So i recommend keeping a close eye on a syslog to see what traffic is trying to fly out of your network.