We report a patient with uncontrolled type 2 diabetes mellitus who was found to have subcutaneous emphysema on examination. Left-sided emphysematous pyelonephritis (EPN) due to Escherichia coli was identified as the cause of this finding. Further evaluation revealed that she had septic emboli in the lungs, which was also likely to be due to EPN. This case report highlights the possibility that EPN may present as a subcutaneous emphysema. This also reports the occurrence of septic embolism in EPN.