Septic Pulmonary Embolism with Hepatic and Renal Abscesses in a Diabetic Patient Mimicking Tuberculosis or Metastasis: A Case Report

Septic Pulmonary Embolism (SPE) is a rare but life-threatening pulmonary condition characterised by the embolic spread of infected thrombi from extrapulmonary sources into the lungs. It most commonly occurs as a complication of systemic infections and presents with cavitating lung lesions, respiratory compromise, and multi-organ involvement. Immunocompromised individuals, particularly those with uncontrolled diabetes mellitus, are especially vulnerable to such infections. We present a case of a 41-year-old man with poorly controlled diabetes and a prior clinical diagnosis of pulmonary tuberculosis, who presented with a progressive cough, dyspnoea, and abdominal pain. Imaging revealed multiple cavitary lesions in the lungs, hepatic abscesses, and renal abscesses with partial renal vein thrombosis. Microbiological investigations confirmed infection with Klebsiella pneumoniae and Pseudomonas aeruginosa. A differential diagnosis of SPE, pulmonary tuberculosis, and cystic metastases was considered. The patient initially responded well to culture-sensitive antibiotics and improved glycaemic control. However, three months later, he was readmitted with worsening respiratory symptoms and hyperglycaemia, and despite appropriate interventions, he developed respiratory failure and succumbed to septic shock. This case highlights the diagnostic complexity of SPE, its overlap with other pulmonary pathologies, and the crucial role of metabolic control and vigilant follow-up in diabetic individuals with systemic infections.