Pierzynski's play resulted in the second of four runs in the second inning that enabled the Sox to rally from a three-run first-inning deficit. The Sox went on to win it in the 10th inning when Kevin Youkilis drove in Alejandro De Aza with none out.
The Sox, who were 10-for-15 with runners in scoring position Tuesday and led the majors with a .303 average in that situation, strung together timely hitting in the second after Alex Rios extended his hitting streak to nine games with a double.
Dayan Viciedo and Alexei Ramirez each hit RBI singles, with Pierzynski needing to run over Napoli cleanly to score the second run.
Gordon Beckham snapped a 3-for-24 slump by hitting a two-run, opposite-field double to put the Sox ahead.
Heading into the 10th, however, the Sox had advanced only one runner as far as second base after the second. But De Aza led off the Sox half with a walk and stole second before Youkilis drove him home.
The Sox relied on defense to keep the score tied late in the game. With the go-ahead run at third in the seventh, Beckham ranged far behind second base to make a quick, off-balance throw to retire Michael Young.
In the eighth, De Aza ran far to catch Napoli's shallow fly for the final out before diving across the grass. Matt Thornton, the beneficiary of De Aza's catch, pitched two perfect innings.
Rookie Dylan Axelrod, making his third start since getting promoted from Triple-A Charlotte to replace Philip Humber, survived the first and lasted 52/3 innings and 107 pitches.
The high pitch count, however, might prevent him from starting Sunday's first-half finale against the Blue Jays, although he could get limited work because the Sox have a four-day break.
Axelrod allowed four consecutive hits with two out in the first, and he allowed a solo home run to Josh Hamilton, his 26th, that enabled the Rangers to tie the score in the third.
Axelrod managed to limit the damage thanks to superb defense. The Sox entered Wednesday's game tied with the Mariners with a major-league-best .988 fielding percentage and a major-league-low 34 errors.
Youkilis played a large part in Axelrod's survival. After Axelrod walked Napoli to start the fourth, Youkilis quickly turned a double play.
In the fifth, Youkilis made a barehanded stop and throw to retire Elvis Andrus for the first out. An even more impressive play occurred two batters later when Youkilis made a diving stop across the third-base line before firing across the diamond to retire Adrian Beltre.
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