Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: keflex / orencia / remicade attending: chief complaint: hypotension major surgical or invasive procedure: central venous catheter placement history of present illness: mr. is a 39 yo m with complex medical history, significant for psoriatic arthritis c/b steroid dependence. patient had been tapering his prednisone and his dose was recently changed from 8mg/day to 7mg/day on . he reports feeling more malaise, lethargy and somnolent, but his bp was doing ok at home (pt checks it 3 times daily). on , patient noticed that his evening sbp was down to 100 (baseline of 120-130). on rechecks, it ultimately came down to 50s/40s. patient reports 1 episode of vomiting and 3 falls during that evening, last of which prompted him to call ems. his falls were thought to be from hypotension. he hit his head multiple times on surrounding furniture during these falls as well. . he was brought to center. bp was initially 70/33 at osh where he received 6 l ns and was placed on levophed. labs significant for bun 39, cr 2.8, wbc 8.4, h/h 11.4/34.9, plt 303 bands 12% n 79% l 3% m 5% myelocyte 1%. he received vancomycin 1 g iv, zosyn 3.375 g iv, and hydrocortisone 100 mg before transfer. labs were significant at 4:35 for bnp 105, cpk-mb 0.6, troponini < 0.015, lactic acid 2.9, phosphorous 5.9, cr 2.8, bun 39. cxr with no acute cardiopulmonary process. at this time, he was transferred to for further management. . in the ed at , initial vs were: 96.4 72 109/61 18 100% 2l nc, levo @ .11 mcg/kg/min. a rij central line was inserted, and he was continued on levophed to sbp > 100. he was given potassium chloride 40 meq iv. initial er labs are likely a mistake, given repeat labs have normalized. wbc 8.3 with n 79.8, l 11.6 with no bands, inr 1.2, cr 1.6 (baseline ~ 1.2), ck-mb 3, ctropnt < 0.01, lactate 1.3. ua clean. urine and blood cultures pending. . when he was admitted to the icu, he gave very detailed history as above. he complained of an occipital headache that is similar to his typical headaches. he was given compazine and dilaudid. past medical history: # psoriatic arthritis c/b steroid dependence with exogenous steroid-associated syndrome, relative adrenal insufficiency # vitamin d deficiency # abnormal thyroid function tests. # left gastrocnemius abscess and bacteremia growing mssa ( ). # history of mrsa infection status post eradication in . # morbid obesity. # obstructive sleep apnea, autoset cpap 14-18cmh20 with cflex 2 # irritable bowel syndrome. # hypertension. # diabetes mellitus type 2 on insulin # hyperlipidemia. # peripheral neuropathy. # nonalcoholic fatty liver disease secondary to previous methotrexate treatment. # keratoconus status post bilateral corneal transplant (, ). # status post four anal fistulotomies. # status post tonsillectomy x2 and adenoidectomy. # degenerative joint disease, status post l4/l5 discectomy. # patellofemoral syndrome, status post arthroscopic surgery for both knees x3 each. social history: patient lives with his wife and children. he is currently on disability, previously teacher for autistic children. tobacco: never etoh: occasional family history: mother: ulcerative colitis, hypertension, hypercholesterolemia, and bipolar disorder. father: non smoking-induced copd and hypertension. brother: dermatologic psoriasis and ulcerative colitis. sister: hypertension, hypercholesterolemia. paternal aunt: crohn disease and sarcoidosis. physical exam: on admission: general appearance: overweight / obese head, ears, nose, throat: normocephalic, buffalo hump cardiovascular: distant heart sounds peripheral vascular: (right radial pulse: present), (left radial pulse: present) respiratory / chest: (breath sounds: clear : ) abdominal: soft, non-tender, obese extremities: right lower extremity edema: 1+, left lower extremity edema: 1+ skin: warm, various small cysts/boils, non of which seem particularly actively infected neurologic: attentive, follows simple commands, responds to: verbal stimuli, movement: purposeful, tone: normal, some midline neck discomfort; limited neck rom similar by patient report to chronic state . on discharge: vitals: tm 98.4; tc 98.4; bp 130/p; p 73; rr 18; o2 99% ra general: pleasant man, nad. cushingoid appearance, looks older than his stated age heent: nc/at, op clear, mmm. thick neck with buffalo hump. cv: faint heart sounds but nl s1/s2, without m/r/g. +tender gynecomastia lung: ctab, no crackles or wheezes abdomen: purple striae throughout abdomen, obese, nontender to palpation. +bs ext: both knees with well healed surgical scars, l leg with well healed calf surgical scar. dp/pt pulses 2+ bilaterally. 1+ edema. neuro: grossly intact. conversant. pertinent results: admission lab: 11:19pm glucose-224* urea n-21* creat-1.3* sodium-142 potassium-4.0 chloride-110* total co2-21* anion gap-15 11:19pm ck(cpk)-278 11:19pm ck-mb-3 ctropnt-<0.01 11:19pm calcium-8.8 phosphate-2.7 magnesium-2.0 11:19pm wbc-9.7 rbc-3.90* hgb-11.4* hct-33.2* mcv-85 mch-29.1 mchc-34.3 rdw-15.5 09:14pm lactate-1.4 03:33pm ck-mb-3 ctropnt-<0.01 03:33pm calcium-8.6 phosphate-3.3 magnesium-2.0 03:33pm haptoglob-296* 03:33pm cortisol-8.8 11:00am urine blood-lg nitrite-neg protein-neg glucose-300 ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-neg . discharge lab: 08:25am blood wbc-7.5 rbc-3.90* hgb-11.2* hct-32.4* mcv-83 mch-28.7 mchc-34.5 rdw-15.9* plt ct-254 08:25am blood glucose-125* urean-13 creat-0.9 na-142 k-3.7 cl-108 hco3-24 angap-14 08:25am blood ck(cpk)-51 03:18am blood alt-14 ast-14 ld(ldh)-251* alkphos-38* totbili-0.2 08:25am blood calcium-8.9 phos-3.3 mg-2.3 ==================== imaging: cxr: the lungs are low in volume which results in crowding of the bronchovascular structures. no pulmonary edema. the cardiac silhouette is enlarged. the mediastinal silhouette remains widened, compatible with mediastinal lipomatosis as noted on prior ct. hilar contours are unchanged. no focal consolidation, pleural effusion or pneumothorax is present. ct-cervical spine: slightly limited eval of lower cervical spine due to pt size. no acute fx or malalignment. if concern for ligamentous or cord injury, mri should be obtained. nchct: no acute intracranial abnl. ====================== microbiology: bcx ngtd, ucx negative mrsa screen negative c diff toxin a &b negative brief hospital course: assessment and plan: 39m with complex history including psoriatic arthritis on chronic steroid therapy presents with hypotension requiring pressors. # shock (adrenal insufficiency & hypovolemia): patient presented to hospital with malaise and falls for the past week. the day prior to presenation he took his bp meds (carvedilol - 12.5 mg and torsemide 100 mg) despite spbs in the 40s, and fell several times. he remained hypotensive in the 90s systolic at the osh despite fluid resucitation, stress-dose steroids, and vasopressors. concern was for hypovolemic shock in the setting of fluid restriction and increased diuretic doses versus septic shock given his immunosuppressed state versus adrenal insufficiency given his chronic steroid usage. mi was ruled out with serial enzymes. cultures were negative at hospital, so antibiotics were stopped. endocrine was consulted who felt that adrenal insufficiency was likely contributing to his hypotension but was not the primary cause. vasopressors were stopped in the micu and his blood pressures were stable on transfer. his blood pressure remained stable while his stress steroid was tapered down and he was started on 10 mg of po prednisone daily. he will be discharged home with a rescue dose of 4 mg im dexamethasone. # syncope with trauma: the patient had several falls prior to admission. he struck his head several times with enough force to damage a wall and break a piece of furniture, which raised concern for head or neck injury. head and c-spine ct were negative for acute injury. he had some pain at the trauma site which were treated with tylenol. # chest pain: symptoms correlated with hypotension and resolved with normalization of blood pressure. initial biomarkers at osh and bimdc not suggestive of acs. troponin was <0.01 x2 at this hospital. no complaint of chest pain at the time of discharge. # acute renal failure: cr was 2.8 at osh with trend to 1.2 with volume resuscitation. this was likely pre-renal in etiology. by the time of discharge, it had downtredned back to his baseline cr of 0.8. # steroid-induced fluid retention: patient appears obese with edema likely from underlying steroid-induced fluid retention. he has been previously evaluated by cardiology with no apparent cardiac, renal, or hepatic etiologies of fluid. his spironolactone and torsemide were held in the setting of his hypotension. his torsemide was started at 50 mg daily on given his increasing peripheral edema. patient was instructed to continue taking 50 mg torsemide daily for 3-4 days after discharge while monitoring blood pressure. he was also instructed to increase the dose to 100 mg torsemide daily (torsemide) afterwards if peripheral edema worsened. # psoriatic arthritis: azathioprine and ustekinumab were held in the acute setting. azathioprine was restarted on per rheumatology recommendation. # diarrhea: pt developed diarrhea night of , characterized by crampy abdominal pain relieved with defecation, typical of his ibs flare. stool sample was sent for c diff toxin and was negative. donnatal was ordered for symptom relief. patient will follow up with dr. for his ibs as outpatient. # hypertension: his carvedilol and diuretics were initially held in the setting of hypotension. carvedilol was restarted at half dose after his blood pressure normalized given his ventricular ectopy. he will follow up with his pcp and primary cardiologist to adjust carvedilol dose as needed. # dm2: was put on 70% home dose of lantus with an nph sliding scale while npo. consult was obtained in order to allow the patient to do carb counting like he does at home. his lantus dose was changed to 20 unit in am and 29 unit in pm. he continued premeal carb counting with adequate control of his blood glucose. he will go home with increased lantus dose and continue carb counting at home. # hl: atorvastatin was initially held in the acute setting. it was restarted in the icu and continued on the floor. he will continue the medication at home at full 80 mg daily dose, as he has tolerated this dose in the past, does not have any interacting medication and has normal alt/ast and ck. # peripheral neuropathy: nortriptyline, pregabalin, tizanidine were initially held in the acute setting. they were restarted on at home dose, and he will continue those at home. # prolonged qtc: etiology unknown as no overt qtc prolongating drugs, but was seen on previous studies. patient received serial ekgs and lytes, both of which normalized. he was monitored on tele which showed known ventricular ectopic beats and prolonged qtc. both of them remained stable. he will follow up with dr. after discharge. # osa: continued on home cpap # normocytic anemia: osh hgb 11.4, admission hgb 6.4 (likely due to drawing labs off a vein with fluids running in) with repeat 11.7. be marrow suppresion from azathioprine and underlying chronic inflammation. his hemoglobin remained stable between 10.1 and 11.7. medications on admission: -albuterol sulfate - 90 mcg hfa aerosol inhaler - 2 puffs po four times a day -atorvastatin - 80 mg tablet - 1 tablet(s) by mouth once a day -azathioprine - 50 mg tablet - two(2) tablet(s) by mouth in the morning, three(3) at night -carvedilol - 12.5 mg tablet - 1 (one) tablet(s) by mouth twice a day -clobetasol - 0.05 % ointment - aaa body twice a day use for up to 2 weeks only, then as needed -ergocalciferol (vitamin d2) - 50,000 unit capsule - 1 capsule by mouth q month -insulin aspart - (prescribed by other provider) - dosage uncertain -insulin detemir - (prescribed by other provider) - 20 qam and 24 qhs -lidocaine - (prescribed by other provider) - 5 % (700 mg/patch) adhesive patch, medicated - to ankle/knee 12 hours on and then 12 hours off prn -nortriptyline - (prescribed by other provider) - 25 mg capsule - 1 capsule(s) by mouth at bedtime -phenobarb-hyoscy-atropine-scop - (prescribed by other provider; dose adjustment - no new rx) - 16.2 mg-0.1037 mg-0.0194 mg-0.0065 mg tablet - 1 to 2 tablet(s) by mouth four times a day as needed -prednisone - 5 mg tablet - 1 tablet by mouth daily in addition to 1mg tabs taken separately -prednisone - 7 mg tablet po qd -pregabalin - 75 mg capsule - 1 capsule(s) -spironolactone - 200 mg tablet by mouth daily -tizanidine - 4 mg tablet - 2 tablet(s) by mouth at night, may take 1 prn for severe pain and spasm -torsemide - 100 mg tablet - 1 tablet(s) by mouth once a day -ustekinumab - 90 mg/ml syringe - 90 mg sub-q weeks 0 - 4; then every 12 weeks . medications - otc aspirin - (otc) - 81 mg tablet - one tablet(s) by mouth once a day calcium carbonate-vitamin d3 - (prescribed by other provider) - 500 mg (1,250 mg)-400 unit tablet, chewable - 1 (one) tablet(s) by mouth once a day ferrous sulfate - (otc) - 325 mg (65 mg iron) tablet - 1 tablet(s) by mouth daily discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) inhalation four times a day. 2. carvedilol 6.25 mg tablet sig: one (1) tablet po twice a day. 3. azathioprine 50 mg tablet sig: three (3) tablet po in the evening. 4. azathioprine 50 mg tablet sig: two (2) tablet po in the morning. 5. vitamin d 50,000 unit capsule sig: one (1) capsule po once a month. 6. insulin aspart subcutaneous 7. insulin detemir 100 unit/ml insulin pen sig: twenty (20) unit subcutaneous in the morning. 8. insulin detemir 100 unit/ml insulin pen sig: twenty nine (29) unit subcutaneous at bedtime. 9. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) patch topical on for 12 hours and off for 12 hours as needed as needed for pain. 10. prednisone 5 mg tablet sig: two (2) tablet po once a day. disp:*60 tablet(s)* refills:*0* 11. nortriptyline 25 mg capsule sig: one (1) capsule po hs (at bedtime). 12. phenobarb-hyoscy-atropine-scop 16.2-0.1037 -0.0194 mg tablet sig: 1-2 tablets po up to 4 times a day as needed as needed for diarrhea. 13. pregabalin 75 mg capsule sig: one (1) capsule po bid (2 times a day). 14. tizanidine 2 mg tablet sig: four (4) tablet po qhs (once a day (at bedtime)). 15. stelara 90 mg/ml syringe sig: one (1) syringe subcutaneous every 12 wks. 16. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day. 17. calcium 500 + d 500 mg(1,250mg) -400 unit tablet, chewable sig: one (1) tablet, chewable po once a day. 18. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 19. clobetasol 0.05 % ointment sig: enough to cover affected area topical as needed. 20. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 21. torsemide 100 mg tablet sig: 0.5 tablet po daily (daily). 22. dexamethasone sodium phosphate 4 mg/ml solution sig: one (1) ml injection once as needed for for low blood pressure: please draw this up in with syringe and needle and inject it into your thigh muscle. disp:*4 mg* refills:*0* 23. syringe with needle (disp) 3 ml 25 x 1 syringe sig: one (1) syringe miscellaneous once. disp:*1 syringe* refills:*0* discharge disposition: home discharge diagnosis: primary: hypotension secondary to relative adrenal insufficiency secondary: hypovolemia, irritable bowel syndrome discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure to take care of you during this hospitalization at . as you know, you came into the hospital with low blood pressure and falls. you were admitted into the icu and received intravenous fluid, stress dose (high dose) hydrocortisone and pressors for your low blood pressure. your blood pressure improved after these medications and the pressor was stopped. you were then transferred to the regular medicine floor. your carvedilol and torsemide were restarted at half dose after your blood pressure returned to . your stress dose hydrocortisone was tapered off and you were transitioned to a higher dose of oral prednisone. while these medications were changed, your blood pressure remained normal. . you also had some diarrhea that you thought were similar to ibd flares. your stool was checked for toxin from c. diff and it was negative. . after you go home, please continue to monitor your blood pressure as you were doing. also, please weigh yourself daily to monitor for fluid retention. . these changes were made to your medications: change prednisone to 10 mg by mouth daily change detemir to 20 units in the morning and 29 units in the evening change carvedilol to 6.25 mg by mouth twice daily change torsemide to 50 mg by mouth daily for 3-4 days. if you notice increased swelling in your legs, you can increase torsemide back to 100 mg by mouth daily. stop spironolactone new: dexamethasone 4 mg rescue syringe. please use this if your blood pressure becomes too low. . followup instructions: . department: rheumatology when: friday at 9:30 am with: , md building: lm bldg () campus: west best parking: garage . department: pain management center when: tuesday at 1:40 pm with: , md building: one place (, ma) campus: off campus best parking: parking on site . department: div of gi and endocrine when: friday at 3:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage . name: , specialty: internal medicine address: , , , phone: appointment: tuesday at 9:45am . department: cardiac services when: monday at 8:00 am with: , md building: campus: east best parking: garage procedure: central venous catheter placement with guidance diagnoses: unspecified essential hypertension long-term (current) use of steroids adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified other and unspecified hyperlipidemia pain in joint, lower leg long-term (current) use of insulin morbid obesity hypovolemia glucocorticoid deficiency unspecified hereditary and idiopathic peripheral neuropathy chest pain, unspecified other specified hypotension background diabetic retinopathy other chronic nonalcoholic liver disease cushing's syndrome irritable bowel syndrome nonspecific abnormal electrocardiogram [ecg] [ekg] spondylosis of unspecified site, without mention of myelopathy other fluid overload diabetes with ophthalmic manifestations, type ii or unspecified type, uncontrolled psoriatic arthropathy cornea replaced by transplant 

Answer: The patient is high likely exposed to