Septic Shock Due to Liver Abscess Complicated by Recurrent Heart Failure Exacerbation in a Patient Diagnosed With Heart Failure With Preserved Ejection Fraction (HFpEF).

Liver abscess is a severe infection that can progress to septic shock. Although early fluid resuscitation is recommended in septic shock, patients with heart failure, particularly those with heart failure with preserved ejection fraction (HFpEF), are prone to fluid overload, making volume management challenging. In addition, hemodynamic instability may occur even after source control. We report the case of a 91-year-old man with a history of HFpEF who was transported to our hospital with fever and difficulty ambulating. He was diagnosed with septic shock secondary to a liver abscess caused by Escherichia coli. Initial resuscitation was performed with antibiotics, vasopressors, and approximately 6.5 L of intravenous fluid, followed by percutaneous drainage. Although his hemodynamic status temporarily improved, shock recurred after the drainage procedure. During hospitalization, he experienced multiple episodes of heart failure exacerbation associated with fluid shifts, requiring careful fluid management, including diuretics and respiratory support. His general condition subsequently improved, and he was successfully weaned from intensive care. This case suggests the importance of balancing adequate initial resuscitation with avoidance of fluid overload in septic shock complicated by HFpEF, and the potential for transient hemodynamic deterioration following source control. Individualized fluid management and close periprocedural monitoring are essential in such patients.