Sepsis-related deaths are occasionally encountered in forensic practice. However, forensic pathologists are reluctant to use the terminology “sepsis” or “septic shock” as a cause of death because of the lack of definite morphological evidence. When sepsis is considered a cause of death, pathologic assessment is essential to identify the foci of infection or consequences of sepsis, such as diffuse alveolar damage (DAD). Pneumonia is known to be a common source of sepsis and can develop into DAD with progression of sepsis. The histology of DAD varies according to the immunologic status. An autopsy of a 55-year-old man who died of septic shock with leukopenia revealed only abundant gram-negative bacilli in the alveoli without typical DAD pathology.