ABSTRACT Methicillin‐susceptible Staphylococcus aureus (MSSA) necrotizing pneumonia can progress to severe disease, particularly when Panton–Valentine leukocidin (PVL) is involved. Here we report the case of a previously healthy 56‐year‐old man who developed severe necrotizing pneumonia due to MSSA despite the absence of major toxin genes including PVL. The patient reported a 10‐day history of low‐grade fever and was admitted for bilateral pneumonia with sepsis. Despite antibiotic therapy, his condition rapidly progressed, and chest computed tomography revealed extensive ground‐glass opacities and multiple cavitary lesions. MSSA was isolated from blood and pleural fluid cultures, and polymerase chain reaction confirmed negativity for PVL, toxic shock syndrome toxin‐1, and exfoliative toxin genes. Although the infection improved with antibiotics including clindamycin, a potent toxin suppressor, the patient experienced recurrent refractory pneumothorax due to persistent cavitary lesions that led to prolonged respiratory failure. PVL‐negative MSSA necrotizing pneumonia can be a life‐threatening disease with long‐term complications.
Endo et al. (2026) studied this question.