We present a case of a 60-year-old male who presented with fever, shortness of breath, left upper quadrant pain accompanied by rigors and chills with a two-week history of productive cough. He had left upper quadrant tenderness and bilateral chest crepitations. The patient became tachypneic, dyspneic, and rapidly progressed to septic shock. Chest x-ray findings of bilateral pulmonary infiltrates on admission were not correlating with the severity of his clinical picture, and blood glucose levels were very high despite a negative prior history of diabetes. Abdominopelvic computed tomography (CT) scans revealed left-sided emphysematous pyelonephritis, which was promptly managed by intravenous antibiotics and CT-guided percutaneous drainage, in addition to glycemic control. This was followed by clinical improvement and resolution of the sepsis. This case sheds light on a possible life-threatening manifestation of the hematogenous spread of pneumonia in uncontrolled diabetic patients, and can even be a de novo presentation of diabetes.

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