A 24-year-old man with cystic fibrosis and marked reduction of volume of the left hemithorax caused by skeletal asymmetry and mediastinal shift underwent successful right single lung transplantation with simultaneous left pneumonectomy. Despite significant preoperative microbiologic contamination, it proved possible to sterilize the pneumonectomy space and no airway complications occurred. Good long-term results have been achieved, and the historic assumption that single lung transplantation is unsuitable for patients with septic lung disease is challenged.