The first case in Latvia of Panton - Valentine leukocidin (PVL) positive methicillin susceptible Staphylococcus aureus (MSSA) pneumonia in an adolescent with novel influenza A H1N1 is described. A 15 year old boy was admitted to intensive care suffering from severe respiratory failure with bilateral necrotic pneumonia. The presence of influenza A H1N1 was confirmed by PCR. Invasive S. aureus was spa type t435 and Panton-Valentine leukocidin gene positive. He received therapy with ceftriaxone, oxacillin, clindamycin and oseltamivir phosphate and underwent two chest operations. He was discharged after 58 days in hospital.