Introduction: Emphysematous liver abscess is defined as liver abscess accompanied by gas formation. It constitutes 6-24% of total pyogenic liver abscess, with mortality rate reaching as high as 27%. Typically, it is associated with poorly-controlled Diabetes Mellitus (DM) and the commonest causative organism is by Klebsiella Pneumoniae. Case Report: This is a 36 years old gentleman with underlying DM presented with 1 week history of abdominal pain, loose stool, vomiting and lethargy. Upon arrival to emergency department, he was tachycardic and restless with examination showed generalized abdominal guarding. Laboratory investigations showed leucocytosis, metabolic acidosis, unrecordable serum glucose level with high serum ketone. The patient was treated as Diabetic Ketoacidosis and septicaemic shock. He was intubated and then later was managed in intensive care unit for 1 week. Abdominal Computed-Tomography (CT) scan revealed lobulated area of lucency in segment 6 of the liver measuring 4.7x5.9x6cm which raised the diagnosis of emphysematous liver abscess. Emergency CT-guided percutaneous drained out 12cc of pus and gas. He was treated with IV meropenem for 1 week followed by oral Augmentin for another 5 weeks. A follow up USG 6 weeks later showed no residual liver abscess. Patient remained well and asymptomatic. Conclusion: Despite presented in severely ill conditions, he recovered well due to early percutaneous intervention and broad-spectrum antibiotics such as Meropenem which was constituted early, targeting the most common causative organism.