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: indocin / clinoril / naproxyn / allopurinol / sodium thiosulfate / probenecide / suldinac / indomethacine / heparin agents attending: chief complaint: weakness and hypotension major surgical or invasive procedure: picc line (non- heparin dependent. patient has heparin induced thrombocytopenia and cannot be given ever again). history of present illness: 69 yo m h/o crohn's disease, psoriatic arthritis, gout presenting with 2 mo nonbloody diarrhea and abdominal pain, weakness, and mild confusion per son. over last two months, patient has felt weak at home and has been having ~10 non bloody bowel watery movements per day. he has felt progessively faigued to the point he cannot stand or perform adls. he also has been experiencing a dull abdominal pain, non radiating. only alleviating factor is prednisone, which he has taken occasionally for gout, and he notes that his abdominal pain resolves completely. otherwise he says his snse of taste has deteriortated and as such he has been eating very little. his son is also concerned about that he has been "slow" and confused lately. fell 2 weeks ago getting out of bed and hit head. no f/c/v. of note patient has been in discussion with his pcp, at gastroenterologist at to start embrel for both his psoriatic arthritis and his crohn's disese. per patient, he had some "blood in his urine" and was awaiting a urology w/u prior to starting embrel. on arrival to the ed vs were t 97.8 hr 93 bp 131/67 rr 20 100%/ra 10 mins after arrival, triggered for hypotension with systolic bp 60s. awake, alert, not tachycardic. labs significant for wbc 12.2 with 85% neutrophils, k 2.2, lactate 4.0, ddimer 1122. cxr wnl. cta chest/abd/pelvis showed no acute process. ecg unremarkable per report. given 5l ns, po k 40meq, 1l ns + 40kcl. sbp initially improved to 90s, then decreased to 80s. started levophed peripherally. difficult to place central line. tried right subclavian. right ij tried, punctured artery. cxr post line placement, initally read as l ptx, now read as skin fold. currently has right femoral triple lumen, placed sterile. also has 18g left arm. vs on transfer t 97.4 hr 71 bp 115/57 rr 18 dpo2 100ra, all on 0.2 of levo. only 70 cc uop in ed. on arrival to the icu, patient is awake, mentating well, and has no complaints. past medical history: -crohn's disease on mesalamine -psoriasis -psoriatic arthritis -hypertension -gerd -hyperuricemia -anxiety -cholelithiasis -multiple liver hypodensities seen on ct, most likely cysts -left renal cyst -impaired glucose tolerance -ascending colon adenoma, removed () -obesity social history: lives by himself in . ambulates with crutch. worked for department of defense. denies etoh use. denies hx of tobacco smoking or any other drug use. family history: dad -arthritis mom -htn, brain aneurysms sister-cll, disease physical exam: admisson exam: vs: 115/66, hr 66 af general: fatigued-appearing man in nad, obese, appropriate heent: mm dry neck: jvp 6cm, numerous puncture sites of r neck lungs: cta bilat, no r/rh/wh, good air movement, resp unlabored. heart: rrr, no mrg, nl s1-s2. abdomen: soft/nt/nd, no masses or hsm, no rebound/guarding, bs+ extremities: wwp, no c/e, 2+ peripheral pulses. bilateral ulnar deviation. prominent second and third mcps. 2+ pitting edema bilaterally. sausage finger deformities, with multiple mobile totally eroded joint spaces in fingers. skin: multiple scaly, erythematous plaques over extremities and trunk neuro: awake, a&ox3. discharge: vitals: 97.7 110/70 70 20 96 ra general: fatigued-appearing man in nad, obese, appropriate heent: mm dry lungs: cta bilat, no r/rh/wh, good air movement, resp unlabored. heart: rrr, no mrg, nl s1-s2. abdomen: soft/nt/nd, no masses or hsm, no rebound/guarding, bs+9+ extremities: warm, well perfused, 2+ dp pulses, 3+ le pitting edema going up to upper thighs b/l, sausage finger deformities b/l with e/o ulnar deviation b/l --> r arm with bruising around picc site, slightly swollen skin: multiple scaly, erythematous plaques over extremities and trunk, numerous areas of skin breakdown scattered all over body neuro: awake, a&ox3 pertinent results: admission labs: 04:05pm blood wbc-12.0*# rbc-3.84* hgb-11.6* hct-37.1* mcv-97 mch-30.2 mchc-31.2 rdw-16.4* plt ct-219 04:05pm blood neuts-85.1* lymphs-11.5* monos-3.0 eos-0.1 baso-0.3 05:03pm blood pt-17.8* ptt-32.2 inr(pt)-1.7* 04:05pm blood glucose-73 urean-10 creat-1.2 na-139 k-2.2* cl-95* hco3-27 angap-19 04:05pm blood alt-18 ast-39 alkphos-125 totbili-1.2 01:35am blood albumin-1.7* calcium-5.6* phos-2.6* mg-1.3* 10:01pm blood type- po2-63* pco2-32* ph-7.49* caltco2-25 base xs-1 comment-green top 04:18pm blood lactate-4.0* 01:57am blood lactate-1.4 discharge labs: imaging: -cxr (): portable upright ap view of the chest: there is little interval change from the prior study. the heart size is within normal limits. the aorta remains markedly tortuous. superior mediastinum remains widened, which on the prior chest ct from is attributable to mediastinal fat and vessels. pulmonary vascularity is not engorged. there is subsegmental atelectasis in the left lung base. mild elevation of left hemidiaphragm appears unchanged. no pleural effusion or pneumothorax is present. no areas of focal consolidation are demonstrated. there are no acutely displaced rib fractures visualized. impression: no significant interval change from the prior study. no acute intrathoracic process demonstrated. -ct head (): no evidence of acute intracranial process. -ct abd/pelvis (): 1. no evidence of pulmonary embolism or acute aortic pathology. 2. focal inflammatory changes of the sigmoid colon likely represent acute exacerbation of crohn's colitis. colonoscopy is recommended after remission of acute process to exclude underlying mass lesion. 3. diffuse regular thickening of the gastric and small bowel folds is consistent with bowel wall edema likely from hypoproteinemia or portal hypertension. 4. fatty infiltration of the liver associated with signs of portal hypertension including a splenorenal shunt and small volume ascites. more severe chronic liver disease such as hepatic fibrosis or cirrhosis may be present and clinical correlation is advised. 5. gallstone, unchanged compared with prior exam. 6. multiple hypodensities in the liver, unchanged from the prior studies, likely cysts, but correlation with prior imaging studies performed at other institutions (atrius) is recommended. -tte (): the left atrium is mildly dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. there is an anterior space which most likely represents a prominent fat pad. : egd: impression: normal mucosa in the duodenum (biopsy) otherwise normal egd to third part of the duodenum recommendations: normal egd. see colonoscopy report for further details. follow up biopsy results : findings: protruding lesions a single sessile 2 mm non-bleeding polyp of benign appearance was found in the ascending colon. a single-piece polypectomy was performed using a cold forceps in the ascending colon. the polyp was completely removed. other diffuse erythema, congestion, friability and superficial ulceration of the mucosa more severe from the rectum to mid-descending colon. the remainder of the descending colon, transverse and ascending colon had patchy disease. this is consistent with crohn's colitis. the terminal ileum mucosa appeared normal. cold forceps biopsies were performed for histology at the cecum, transverse colon, descending colon, sigmoid, rectum. impression: polyp in the ascending colon (polypectomy) diffuse erythema, congestion, friability and superficial ulceration of the mucosa more severe from the rectum to mid-descending colon. the remainder of the descending colon, transverse and ascending colon had patchy disease. this is consistent with crohn's colitis. the terminal ileum mucosa appeared normal. (biopsy) otherwise normal colonoscopy to cecum and terminal ileum recommendations: follow up biopsy results. follow up per inpatient gi team recommendations 04:51am blood wbc-4.7 rbc-2.50* hgb-7.7* hct-25.1* mcv-101* mch-30.8 mchc-30.6* rdw-19.0* plt ct-102* 04:05pm blood neuts-85.1* lymphs-11.5* monos-3.0 eos-0.1 baso-0.3 01:35am blood neuts-85.5* lymphs-11.0* monos-3.2 eos-0.1 baso-0.2 09:15pm blood pt-14.6* ptt-50.3* inr(pt)-1.4* 04:51am blood pt-16.9* ptt-69.0* inr(pt)-1.6* 12:18pm blood ptt-66.3* 06:34am blood pt-12.4 ptt-43.3* inr(pt)-1.1 01:35am blood esr-17* 06:34am blood glucose-84 urean-6 creat-0.6 na-146* k-3.1* cl-113* hco3-26 angap-10 04:51am blood glucose-150* urean-7 creat-0.7 na-142 k-5.6* cl-112* hco3-28 angap-8 09:24am blood glucose-141* urean-7 creat-0.7 na-141 k-5.9* cl-110* hco3-27 angap-10 12:18pm blood na-143 k-4.1 cl-110* 06:34am blood glucose-155* urean-8 creat-0.6 na-142 k-4.6 cl-109* hco3-24 angap-14 06:34am blood mg-1.9 04:51am blood calcium-6.9* phos-2.6* mg-2.1 09:24am blood calcium-7.1* phos-2.5* mg-2.1 06:34am blood quantiferon-tuberculosis gold-pnd 07:11am blood heparin dependent antibodies- heparin dependent antibodies positive 08:57pm blood serotonin release assay-pnd brief hospital course: 69m with h/o psoriasis, recent admission for lle pain and weakness, recently diagnosed crohn's disease, presents with diarrhea concerning for crohn??????s flare with hypotension secondary to likely hypovolemia. . # hypotension: the patient was initially admitted to the micu for hypotension. at admission, he was likely hypovolemic from gi losses and poor po intake prior to admission. there was also concern for sepsis and he was started on cipro/flagyl to cover for gi sources. he continued to be hypotensive after fluid resuscitation and intermittently required levophed to maintain maps >60. a tte was obtained which did not show any significant cardiac dysfunction. after being called out from the unit, the patient's pressures were stable. of note, atenolol was held given hypotension and not restarted bp/hr within acceptable range. . # crohn's flare: as above, he was started on cipro/flagyl and continued on mesalamine. gi was consulted who recommended mr enterography when clinically stable. the patient was found to have new disease in terminal ileum, and will likely initiate an immunomodulator as an outpatient. he was started on iv steroids, and later transitioned to po prednisone. steroids were continued as there was good response given improvement in crp. he completed a course of cipro/flagyl until after his colonoscopy and egd on (report in results section). stool studies were negative, and patient was also cdiff negative. he continues on mesalamine. # macrocytic, normochromic anemia: treated empirically with im vitamin b12 given macrocytis anemia and crohn's disease. anemia of chronic disease likely also contributing. # fatty liver: inr elevated to 1.7 at admission and albumin was also 1.7. concern for malabsorption from his crohn's. also found to have evidence of fatty liver disease on his ct this admission. the patient will need outpatient liver follow up. # ?hit: during this admission, the patient's platelets were trending down and he developed a clot at the site of his picc line. there was concern for hit, and the patient's sc heparin was stopped. because of psoriasis and le edema, the patient could not tolerate pneumaboots. given his increased risk of venous thromboembolism given his underlying ibd, the patient was started on fondaparinux. this was soon stopped as he started having bloody bms. his pf4 ab test became positive at 1.44 and he was resumed on fondaparinux for treatment of hitt with outpatient followup with no major rectal bleeding. given his ibd, it is acceptable for him to have a small amount of bloody stools but should large amount of bleeding occur, one must consider relationship to anticoagulation. . # elevated inr: no evidence of hemolysis, making dic less concerning. will follow coags daily. possibly poor nutrition (albumin 1.7 on admission) and lack of absorption crohn??????s. # code status: full # transitional issues: - quantiferon gold assay pending. - liver followup - hematology followup and gi followup re: anticoagulation and ? anti-tnf therapy respectively. - seratonin release assay pending medications on admission: - dicyclomine (bentyl) 10 mg oral capsule take 1 tab 3x day as needed for pain - alprazolam 0.5 mg oral tablet 1 tab once daily as needed for insomnia or anxiety - colchicine (colcrys) 0.6 mg oral tablet take 1 tablet daily - clobetasol-emollient (olux-e) 0.05 % topical foam apply once to twice daily (not to face) - mesalamine (apriso) 0.375 gram oral capsule, ext release 24 hr take 4 tabs po qd - sulfacetamide-sulfur-avobenzon (prascion ra) % topical cream apply two times per day for 2 weeks - atenolol 25 mg oral tablet take 1 tablet twice daily for a total of 50mg - clobetasol (temovate) 0.05 % topical ointment psorisis , avoid face and skin folds - hydrocortisone valerate (westcort) 0.2 % topical cream apply two to three times daily as directed - omeprazole 20 mg oral capsule, delayed release(e.c.) take 1 cap . one 30 min before breakfast and one 30 moin before dinner discharge medications: 1. alprazolam 0.5 mg tablet sig: one (1) tablet po once a day as needed for anxiety. 2. colchicine 0.6 mg tablet sig: one (1) tablet po once a day. 3. clobetasol-emollient 0.05 % foam sig: one (1) application topical (2 times a day) as needed for psoriasis. 4. mesalamine 0.375 gram capsule, ext release 24 hr sig: four (4) capsule, ext release 24 hr po daily (). 5. prednisone 20 mg tablet sig: two (2) tablet po daily (daily). 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 7. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 8. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. 10. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for rash. 11. hydrocortisone valerate 0.2 % cream sig: one (1) application topical daily () as needed for rash. 12. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 13. fondaparinux 7.5 mg/0.6 ml syringe sig: 7.5 mg subcutaneous daily (daily). discharge disposition: extended care facility: hospital for continuing medical care - ( center) discharge diagnosis: primary: crohn's disease heparin induced thrombocytopenia secondary: psoriatic arthritis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , it was a pleasure taking care of you while you were admitted to . you were admitted to the hospital because you very weak at home and having profuse amounts of diarrhea. because you blood pressures were very low, likely in the setting of not eating a lot and having a lot of diarrhea, you were admitted to the intensive care unit where you were given medications to help support your blood pressure. you were also given medications to treat your crohn's flare. it is very important that you follow up with your outpatient gi who can also address any concerns regarding your liver function. it is likely that you will need to start another medication, as imaging from this admission showed that your crohn's disease is spreading. finally, during this hospitalization, we believe you've developed an allergy to heparin called heparin-induced thrombocytopenia. thus, you should never take heparin again until we clarify this reaction. there is one final blood test pending in the lab to guide us in this respect. regarding your medications... medications started that you should continue: fondaparinux, nystatin, vitamin d3, calcium carbonate medications stopped this admission: atenolol, dicyclomine medication doses changed that you should follow: none otherwise, it is very important that you take all of your usual home medications as directed in your discharge paperwork. please followup with your primary care doctor regarding the course of this hospitalization. followup instructions: gastroenterology appointment: , at 12pm with: , md location: , phone: department: hematology/oncology when: friday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: friday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: endoscopic polypectomy of large intestine esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of large intestine central venous catheter placement with guidance diagnoses: acidosis anemia, unspecified esophageal reflux unspecified essential hypertension gout, unspecified hypopotassemia other shock without mention of trauma other complications due to other vascular device, implant, and graft obesity, unspecified hypovolemia benign neoplasm of colon other and unspecified coagulation defects unspecified intestinal malabsorption other chronic nonalcoholic liver disease heparin-induced thrombocytopenia (hit) nutritional marasmus regional enteritis of small intestine with large intestine psoriatic arthropathy acute venous embolism and thrombosis of subclavian veins other pancytopenia acute venous embolism and thrombosis of axillary veins 

Answer: The patient is high likely exposed to