Older adults with pyogenic liver abscess generally have outcomes similar to those of younger adults. Their hospital stay may be longer, and they are more likely to have multiple comorbidities. Older adults with pyogenic liver abscesses are more likely to have a biliary disorders or an underlying malignancy, whereas younger adults with pyogenic liver abscesses are more likely to be male and to have right upper quadrant tenderness, alcoholism, and a cryptogenic etiology. The diagnosis of pyogenic liver abscess is challenging because of its vague presenting symptoms and signs and nonspecific laboratory findings. Intraabdominal infections such as diverticulitis and appendicitis can also cause liver abscesses. Right upper quadrant tenderness occurs less frequently in older than in the young adults with pyogenic liver abscesses despite the higher frequency of biliary disorders in older adults.4 This man’s presentation with hypotension, leukocytosis, and delirium and his ineffective, prolonged course of antibiotics were important additional features that were noted.