A 28-year-old drug addict who had injected intravenously died of hepatic failure and coma caused by fulminant hepatitis (simultaneously: hepatitis A, persistent hepatitis B, hepatitis C and superinfection by delta hepatitis). Liver histology disclosed cirrhosis with severe necrotizing hepatitis and extensive microvesicular steatosis, compatible with a delta virus infection. Moderate pulmonary fat embolism (grade I-II according to Falzi) was accompanied by fat deposits in alveolar macrophages. It is postulated that protracted fat mobilization from necrotizing hepatocytes may be the cause of pulmonary fat embolism; the extravasation of fat from the vessels into the alveoli results in phagocytosis by alveolar macrophages.