Distant metastasis and paraneoplastic syndromes are often seen in small cell lung cancer patients, and can sometimes mislead in the diagnosis of lung cancer. We report a 69-year-old man presenting with persistent fever for days and an initial diagnosis of liver abscess. His condition did not improve after antibiotic treatment. Small cell carcinoma was proved by echo-guided liver biopsy. A small nodule in the right lung, which was barely seen in the initial chest radiograph, was detected by chest CT scan. Small cell lung cancer with liver metastasis was documented. The hepatic lesion and fever improved after chemotherapy.