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Altered Mental Status in an 81-Year-Old Man

An 81-year-old African-American man presented to the emergency department from a nursing home with acute mental status changes. His past medical history was significant for hypertension, end-stage renal disease requiring hemodialysis, and congestive heart failure with respiratory failure. His past surgical history was significant for a suprapubic catheter placement due to urethral stricture. On physical examination, the patient was febrile and was on ventilatory support due to respiratory failure. He was arousable. Abdominal examination revealed suprapubic tenderness. Laboratory testing revealed a white blood cell count of 23 × 103/μL (normal, 4.5–11.0 × 103/μL), and liver function panel results were as follows: total bilirubin, 2.0 mg/dL (normal, 0.3–1.1 mg/dL); direct bilirubin, 1.1 mg/ dL (normal, 0.1–0.4 mg/dL); alkaline phosphatase, 262 U/L (normal, 35–150 U/L); aspartate aminotransferase, 291 U/L (normal, 1–36 U/L); and alanine aminotransferase, 65 U/L (normal, 1–45 U/L). Urinalysis was significant for 10 red blood cells/high-power field and was positive for leukocyte esterase. In the hospital, the patient required intubation and ventilation and aggressive resuscitative measures, including pressor support. The patient was treated with broad-spectrum antibiotics for presumed urosepsis-related septic shock. As his abdominal examination was unreliable, a computed tomography (CT) scan of the abdomen and pelvis was ordered (Figure). WHAT IS YOUR DIAGNOSIS?