We report a fatal case of methicillin-resistant Staphylococcus aureus (MRSA)-induced necrotizing pneumonia that was refractory to adequate vancomycin treatment (trough value, 13.1 µg/mL), drainage of a hydropneumothorax, and veno-arterial extracorporeal membrane oxygenation. MRSA infection can cause rapidly progressive disease with a high case fatality rate, even with appropriate treatment.