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Necrotizing Pneumonia Caused by PVL-Negative Methicillin-Susceptible Staphylococcus aureus Complicated by Refractory

Shun Endo1, Tomoka Yasuda1, Makoto Izumi1

  • 1Department of Pulmonology Soka Municipal Hospital Saitama Japan.

Respirology Case Reports
|January 26, 2026
PubMed

Insights

Severe necrotizing pneumonia caused by Panton-Valentine leukocidin-negative methicillin-susceptible Staphylococcus aureus (MSSA) can be life-threatening. This case highlights potential long-term complications even with appropriate treatment.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Microbiology

Background:

  • Methicillin-susceptible Staphylococcus aureus (MSSA) can cause severe necrotizing pneumonia, often associated with Panton-Valentine leukocidin (PVL).
  • Necrotizing pneumonia can lead to rapid deterioration and significant morbidity.

Purpose of the Study:

  • To report a case of severe necrotizing pneumonia caused by PVL-negative MSSA in a previously healthy adult.
  • To highlight the potential for severe disease and long-term complications in PVL-negative MSSA pneumonia.

Main Methods:

  • Case report of a 56-year-old male with severe necrotizing pneumonia.
  • Identification of MSSA from blood and pleural fluid cultures.
  • Polymerase chain reaction (PCR) testing for key toxin genes (PVL, TSST-1, exfoliative toxins).

Main Results:

  • The patient presented with bilateral pneumonia, sepsis, and rapid progression despite antibiotic therapy.
  • Chest CT revealed extensive ground-glass opacities and multiple cavitary lesions.
  • MSSA was isolated, and PCR confirmed the absence of PVL, TSST-1, and exfoliative toxin genes.
  • Despite treatment with antibiotics and clindamycin, the patient developed recurrent pneumothorax and prolonged respiratory failure.

Conclusions:

  • PVL-negative MSSA necrotizing pneumonia can present as a severe, life-threatening condition.
  • Persistent cavitary lesions can lead to significant long-term complications such as refractory pneumothorax and respiratory failure.
  • This case underscores the importance of considering severe outcomes even in the absence of common virulence factors.
Keywords:
Panton–Valentine leukocidinmethicillin‐susceptible Staphylococcus aureusnecrotizing pneumoniapneumothorax

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