Deep learning-based joint source-channel coding (deep JSCC) has been demonstrated to be an effective approach for wireless image transmission. However, many current approaches utilize an autoencoder framework to optimize conventional metrics such as Mean Squared Error (MSE) and Structural Similarity Index (SSIM), which are inadequate for preserving the perceptual quality of reconstructed images. Such an issue is more prominent under stringent bandwidth constraints or low signal-to-noise ratio (SNR) conditions. To tackle this challenge, we propose DiffJSCC, a novel framework that leverages the prior knowledge of the pre-trained Stable Diffusion model to produce high-realism images via the conditional diffusion denoising process. First, our DiffJSCC employs an autoencoder structure similar to prior deep JSCC works to generate an initial image reconstruction from the noisy channel symbols. This preliminary reconstruction serves as an intermediate step where robust multimodal spatial and textual features are extracted. In the following diffusion step, DiffJSCC uses the derived multimodal features, together with channel state information such as the signal-to-noise ratio (SNR) and channel gain, to guide the diffusion denoising process through a novel control module. To maintain the balance between realism and fidelity, an optional intermediate guidance approach using the initial image reconstruction is implemented. Extensive experiments on diverse datasets reveal that our method significantly surpasses prior deep JSCC approaches on both perceptual metrics and downstream task performance, showcasing its ability to preserve the semantics of the original transmitted images. Notably, DiffJSCC can achieve highly realistic reconstructions for $768\times 512$ pixel Kodak images with only 3072 symbols (<0.008 symbols per pixel) under 1dB SNR channels. The source code is available at https://github.com/mingyuyng/DiffJSCC