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Diabetic patients may experience more severe Staphylococcus aureus-related respiratory tract infections such as necrotizing pneumonia (NP). A 13-year-old girl with uncontrolled diabetes mellitus was admitted to pediatric intensive care unit (PICU) with diabetic ketoacidosis and respiratory distress. Her initial evaluation revealed diffuse pneumonic infiltration that progressed to NP within days. She was intubated and placed on mechanical ventilator (MV) support. Positive inotropes and broad-spectrum antibiotics were initiated. Methicillinresistant S. aureus was isolated from blood and pleural specimen cultures. In spite of aggressive medical treatment, infection could not be controlled and lobectomy was performed. However, the patient was fistulized and right total pneumonectomy was performed on the 16th and 29th days of PICU admission. She gradually got better and was weaned from MV. On the 59th day, she was discharged oxygen-free from the hospital. Early surgical intervention should be considered for the treatment of NP resistant to medical therapy.