A 70 years old male patient underwent surgery on 24/4/16, followed by severe anorexia for which consulted to MD medicine but not responded to oral drugs and get admitted for 2 days to a private hospital where he became drowsy. He visited our hospital in a semi-conscious condition with respiratory distress and oliguria.

Counts are normal but procalcitonin is increased, CSF normal, LFT normal, sr creat 1.5,  sr ammonia normal, electrolytes normal, USG normal. What may be provisionally diagnosed?