A 67-year-old diabetic woman was admitted with abdominal pain one day after being discharged from other hospital, where she had been diagnosed with urinary infection and sepsis. A pyogenic liver abscess was detected by ultrasonography in this institution. Antibiotic therapy was started and a percutaneous drainage was attempted, but major clinical deterioration with irresponsive septic shock and acidosis ensued. Autopsy confirmed pyogenic liver abscess and findings of septic shock. Rarely documented microscopic septic pulmonary emboli were detected. This case illustrates the importance and difficulty of early recognition of pyogenic liver abscess and its severe septic complications in diabetic patients. Microscopic septic pulmonary embolism is a rare finding in pyogenic liver abscess cases and its precise clinical significance is unknown.