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: penicillins / raw egg yolk / bactrim / flu shot attending: chief complaint: abnormal labs major surgical or invasive procedure: picc line lumbar puncture thoracentesis history of present illness: 69 year old female with a questionable history of sarcoidosis with massive lad leading to lymphedema and a recent left-sided ureteral stenosis s/p stent () presents from rehab with elevated creatinine, hyponatremia, and hyperkalemia. she is complaining of pain of her lower extremities and backside, but she has not had any fevers or chills. she is mostly concerned about her sarcoidosis and wants to "start treatment already and stop playing around with medications". she is frustrated that she does not have the energy to do anything and feels like she has no purpose, like she's just doing what the people at the nursing home tell her to do. per the nursing home records, her labs were notable for hct 29.2, na+ 119 (from 122 on ), k+ 6.2 (5.7 on ), creatinine 3.4 (up from 2.0 on ). due to the trend of the labs, she was sent to for further evaluation and management. she has had a history of presumed sarcoidosis since , though no definitive diagnosis has ever been made because her biopsy results have been inconclusive. she had been refractory to high-dose steroids and her subclavicular lymphadenopathy has left her with massive lymphedema. her course has been complicated by multiple hospitalization and rehab stays since , punctuated by an episode of severe hypercalcemia and a 30-lb weight loss, along with electrolyte abnormalities. she was seen by rheumatology (dr. ) in and was referred for a repeat biopsy. this biopsy, too, was rather atypical for sarcoidosis, though the read seems to indicate a diagnosis favoring sarcoidosis. however, it has not been steroid-responsive. as such, she was started on methotrexate and other diagnoses such as lymphoma were considered, but not confirmed by biopsy. her muscle weakness has been attributed to steroid myopathy. upon seeing her rise in creatinine, methotrexate was stopped and rheumatology wanted to start imuran. prior work-up showed negative and anca, esr of 18, and an abnormal spep with a igg lambda monoclonal population of about 3% of the total protein population. renal (dr. ) was consulted around the time of her admission to for a similar set of circumstance (though she was hypokalemic at that time) and outlined the following issues: (1) creat 1.5 with low grade proteinuria (up/cr ~1.5), (2) edema with hypoalbuminemia (mid 2s), (3) hyponatremia of likely multifactorial etiologies, (4) left ureteral obstruction with stent placed in in , as above. in the ed, initial vitals were: 99.3 80 101/52 18 100% ra. exam was notable for aaox3, but occasionally confused at times and yelling, severe le edema bilaterally with ulcers on right lateral lower leg, left dorsal aspect of foot, and left calf. repeat labs here showed na+ 114, k+ 6.5, and creatinine 3.2. ekg unremarkable with normal sinus rhythm and no peaked t waves, but received calcium gluconate and iv regular insulin for treatment of hyperkalemia. she was given morphine for pain control. urinalysis showed pyuria and many bacteria, so she was started on cipro as well. urology was consulted and recommended a non-contrast ct of the abdomen/pelvis, completed prior to her arrival to the icu. renal u/s showed moderate left hydronephrosis, new in comparison to prior study from with visualization of the renal stent (patient reports passing the stent). after a phone call from the icu admitting team, she was given a dose of steroids given her abrupt cessation of prior high-dose steroids. she is being admitted to the icu for severe hyponatremia, hyperkalemia, and . on arrival to the micu, she reiterates her concern about sarcoidosis treatment and wants to be more comfortable in the bed. she is coherent, carrying on a conversation, and alert and oriented. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - lymphadenopathy with lymphedema causing anasarca and hypercalcemia, unresponsive to high-dose prednisone with atypical histiocytes with proliferation in the left nodes ----questionable diagnosis of sarcoidosis since with lung findings and inconclusive biopsy, presumed to have sarcoidosis ----started on methotrexate on ----supraclavicular ln biopsy: atypical histiocyte- proliferation, favor sarcoidosis (post-steroid treatment) ----multiple coccyx and le ulcers - left-sided ureteral stenosis, s/p stenting in - adrenal mass: large 3 cm adrenal gland mass, increased in size from to - spinal stenosis - hypertension - hypercholesterolemia - thyroid disease - gerd - depression social history: denies alcohol or tobacco. she is a retired computer engineer. she has been hospitalized and at rehabs since . family history: no family history of inflammatory or immune diseases. physical exam: admission exam: physical exam: vitals: t: 96.7, bp: 105/60, p: 75, r: 14 o2: 98% on ra general: alert, oriented, no acute distress, able to carry on a conversation heent: sclera anicteric, dry mm, oropharynx clear, perrl neck: supple, jvp flat, no lad cv: regular rate and rhythm, iii/vi holosystolic murmur obscuring s2, no rubs or gallops lungs: bibasilar crackles, no wheezes, rales, rhonchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, with significant 4+ edema and remarkable skin sloughing off her left forefoot with healing ulcers along the anterior surfaces of her toes. scaling over her right extremity. spongy, pitting edema extends all the way up her legs to her groin and lower back skin: multiple stage 2 and 3 ulcers along gluteal folds neuro: cnii-xii intact, strength not assessed, grossly normal sensation, gait deferred on discharge pertinent results: admission labs 03:45pm plt smr-normal plt count-187 03:45pm hypochrom-normal anisocyt-1+ poikilocy-1+ macrocyt-1+ microcyt-normal polychrom-normal ovalocyt-occasional burr-occasional teardrop-occasional 03:45pm neuts-92* bands-2 lymphs-6* monos-0 eos-0 basos-0 atyps-0 metas-0 myelos-0 03:45pm wbc-7.3 rbc-3.12* hgb-9.7* hct-29.5* mcv-95 mch-31.1 mchc-32.9 rdw-19.7* 03:45pm cortisol-33.8* 03:45pm tsh-5.4* 03:45pm osmolal-290 03:45pm calcium-7.7* phosphate-8.2* magnesium-2.1 03:45pm glucose-154* urea n-114* creat-3.2* sodium-114* potassium-6.5* chloride-81* total co2-22 anion gap-18 05:09pm k+-6.2* 08:21pm lactate-2.5* imaging ct abd/pelvis impression: 1. limited study due to lack of iv contrast demonstrates mild left hydronephrosis and hydroureter with the point of transition likely in the proximal to mid left ureter but not clearly identified. no stent or renal stones are identified. 2. mesenteric lymphadenopathy as well as inguinal and iliac lymphadenopathy raises the question of lymphoproliferative disease. mild mesenteric haziness. 3. bilateral small pleural effusions. 4. moderate subcutaneous edema. renal u/s impression: moderate left hydronephrosis with no ureteral stent seen. ct chest conclusion: 1. left soft tissue mass tracking around left subclavian vessels and going to left supraclavicular area is unchanged since . a left supraclavicular lymph node biopsy has been done in ; even if the pathologic report mentionned possible sarcoid, the radiologic appearance, however, is non-specific and malignant disease is also included in the differential diagnosis. all the smaller less than 1 cm central lymph nodes are unchanged. 2. bilateral non-hemorrhagic moderate pleural effusions are new since and are increased since recent abdominal ct of . 3. mixed evolution of the pulmonary nodules. some of them are new, others are worse and some of them have improved. in lower lobes, the lung nodules cannot be compared because of compressive atelectasis and pleural effusions. 4. bronchial wall thickening with atelectasis in lower lobe could be related to aspiration. 5. right adrenal lesion is unchanged since . echo impression: suboptimal image quality. moderate functional mitral stenosis. mild aortic stenosis.mild symmetric left ventricular hypertrophy with preserved regional and global biventricular systolic function. dilated ascending aorta. no discrete vegetation or pathologic regurgitation identified. pft impression: the fvc is moderately reduced. the fev1 is severely reduced. the fev1/fvc ratio is normal. flow-volume loop: moderately reduced flows and volume excursion with very mild expiratory coving and an early termination of exhalation. dlc: the diffusing capacity corrected for hemoglobin is moderately reduced. results are consistent with a restrictive ventilatory defect and moderate gas exchange defect. the fvc may be underestimated due to an early termination of exhalation. brain mri 1. 5-mm left frontal enhancing lesion with slow diffusion. differential diagnosis includes neoplastic process (which is favored), or small infarction. recommend clinical correlations and short-term imaging follow up to assess for interval changes. 2. extensive white matter disease. 3. paranasal sinuses disease as described above. renal u/s findings: the right kidney measures 9.0 cm and the left kidney measures 7.3 cm. there is no evidence of hydronephrosis, stone, or mass in either kidney. the urinary bladder contains a foley and is not distended. small right pleural effusion and small ascites are present. impression: no hydronephrosis in either kidney. the bladder contains a foley catheter and is decompressed. ct chest, abdomen, + pelvis impression: 1. left supraclavicular mass appears similar in size and likely compresses the left subclavian vein, accounting for the left arm swelling. 2. moderate bilateral pleural effusions which are simple fluid in density. although chylothorax is possible due to thoracic duct obstruction from the supraclavicular mass, it is less likely because the fluid density would be expected to be lower given the high fat content of lymphatic fluid. 3. stricture of the intrahepatic portion of the ivc as well as at a point just superior to the bifurcation may be due to sclerosis or post-treatment changes. although this may account for some of the patient's anasarca, non-anatomic causes should also be pursued. 4. stable indeterminate right adrenal nodule may reflect involvement with lymphoma. 5. new splenic infarction. 6. diffuse dilation of the large bowel consistent with ileus. 7. no significant active lymphadenopathy within the chest, abdomen or pelvis aside from the supraclavicular mass discussed previously. 8. trace ascites. 9. severe multilevel degenerative disc disease. cxr impression: ap chest compared to and 12: previous mild pulmonary edema has resolved, but small bilateral pleural effusions and bibasilar atelectasis remain. there is no pneumothorax. heart size is normal. tip of the right pic line ends in the right atrium, and would need to be withdrawn 4.5 cm to reposition it in the low svc. heart size is normal. upper lungs are clear. lue u/s no dvt in the left upper extremity. cxr heart is normal in size and demonstrates left ventricular configuration. the aorta is tortuous and calcified. previously present bibasilar atelectasis has nearly completely resolved, and small pleural effusions have decreased in size with minimal remaining effusions. mri head: impression: slightly decreased diffusion abnormality, with more pronounced decrease in enhancement of left frontal lesion. this may reflect a subacute infarct, although the diffusion abnormality has not changed as rapidly as would be expected for an infarct of this size, or may reflect an underlying mass lesion such as from lymphoma. if untreated, a lymphoma deposit should progress, and not recede as this has. if the patient has received systemic therapy for lymphoma, it is possible that we are observing a partial response. continued followup for resolution or change is recommended to help to differentiate between these potential etiologies. ruq ultrasound: 1. no intra- or extra-hepatic biliary ductal dilatation. 2. sludge-filled gallbladder. 3. small bilateral pleural effusions and trace ascites. ct torso - impression: 1. high-grade small bowel obstruction with the transition point in the distal ileum. new moderate volume ascites, but no free air. 2. enlarging bilateral pleural effusions with right lower lobe atelectasis. probable mild pulmonary edema. 3. stable splenic infarction. 4. no lymphadenopathy within the abdomen, or pelvis. 3.0 cm left supraclavicular mass is unchanged from . 5. stable peripheral splenic infarct. 6. stable indeterminate right adrenal nodule. abdominal plain film 1. gaseous dilatation of the small bowel, increased compared to ct performed with gas evident distally. findings consistent with partial small bowel obstruction with less likely consideration given to ileus (given presence of sbo on recent ct). 2. bibasilar opacifications, likely combination of effusions and atelectasis. microbiology blood cx enterococcus faecium. final sensitivities: high level gentamicin screen: susceptible to 500 mcg/ml of gentamicin. screen predicts possible synergy with selected penicillins or vancomycin. consult id for details. high level streptomycin screen: susceptible to 1000mcg/ml of streptomycin. screen predicts possible synergy with selected penicillins or vancomycin. consult id for details.. daptomycin sensitivity testing performed by etest. daptomycin = 3.0 mcg/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus faecium | ampicillin------------ =>32 r daptomycin------------ s penicillin g---------- =>64 r vancomycin------------ 1 s bottle 2- gran neg rods in aerobic and anaerobic , , , , , blood cultures: no growth picc tip culture: no growth and urine cx: mixed flora consistent with contamination csf cryptococcal antigen: not detected csf culture: pending blood ebv: pending pleural fluid culture: pending pathology bone marrow immunophenotyping: non-specific t cell dominant lymphoid profile; diagnostic immunophenotypic features of involvement by leukemia/lymphoma are not seen in specimen. correlation with clinical findings and morphology (see s12-) is recommended. flow cytometry immunophenotyping may not detect all lymphomas as due to topography, sampling or artifacts of sample preparation. bone marrow and core biopsy diagnosis: cellular bone marrow with involvement by classical hodgkin lymphoma. by immunohistochemistry, cd20 stains scattered cells. rare cells, morphologically consistent with diagnostic -sternberg cells, are positive for cd30 and pax5. cd15 stains neutrophils and bands and together with cd45 is difficult to appreciate reactivity among large atypical cells. tissue slides: pending csf cytology negative for malignant cells. lypmhocytes present. pleural fluid immunophenotyping: pending endocrine labs 06:55am blood 17 hydroxyprogesterone-test 06:55am blood androstenedione-pnd 06:55am blood testost-<12 dhea-so-13 shbg-42 05:50am blood cortsol-42.9* 03:45pm blood cortsol-33.8* 03:45pm blood tsh-5.4* 05:06pm blood pth-282* 05:06pm blood free t4-1.2 05:39am blood vitb12-384 folate-greater th 07:30am blood cortsol-28.0* 11:45am blood cortsol-22.9* 12:15pm blood cortsol-33.8* 01:33pm blood cortsol-40.9* discharge labs brief hospital course: 69 year old female with a history of questionable sarcoidosis with inconclusive prior biopsies, mesenteric lad with lymphedema, and recent left-sided ureteral stenosis, presenting with hyponatremia with hyperkalemia and acute kidney injury, found to have decreasesing wbc count (anc 16), intermittent hypotension, and blood cultures postitive for enterococcus and gram negative rods. patient had a bone marrow biopsy diagnostic for hodgkin's lymphoma. 1. pancytopenia: on , patient developed progressive pancytopenia. bone marrow toxicity due to recent methotrexate, ciprofloxacin, and bone marrow invasion from recently diagnosed hodgkin's disease were considered as possible etiologies. patient had a positive blood culture growing gnr's and sepsis was also considered as an etiology of pancytopenia. bone marrow biopsy from showed classical hodgkin lymphoma. patient was started on neupogen and leucovorin and counts improved (wbc 9.2, anc was >4k, hct 25.2, plt 59) prior to transfer to bmt. counts remained stable with expected decreases after avd therapy. received neupogen and blood products 2. hodgkin lymphoma: patient has a 6+ year history of lymphadenopathy and lymphedema that was previously though to be due to sarcoid. however, her sarcoid was refractory to steroids. several providers have questioned the diagnosis of sarcoid given patient's lack of response to steroids and her multiple biopsies which, by report, were inconclusive but most likely consistent with sarcoid. patient's ct scans seemed more consistent with a lymphoproliferative etiology (i.e. alps - autoimmune lymphoproliferative syndrome; lymphoma). spep showed trace abnormal band, identified as monoclonal igg lambda, representing 3% of total protein. patient had a bone marrow biopsy on showing classical hodgkin lymphoma, which is stage iv given bone marrow involvement. upon hem onc and pathology review of outside hospital slides, -sternberg cells were identified on prior biopsies as early as . patient was transferred to the bmt unit. she had pulmonary function tests showing a decreased dlco and was therefore started on avd chemotherapy with c1d1 on . bleomycin was not given due to potential pulmonary toxicity. patient tolerated her first cycle well without significant side effects. patient had a brain mri demonstrating a lesion in her left frontal lobe that was very concerning for hodgkin's. given the invasiveness of a brain biopsy, a lumbar puncture was performed. csf cytology was negative for malignancy; unfortunately, that result did not definitively rule out cns hodgkins. a repeat brain mri 2 weeks after the initial scan showed decrease in size of brain lesion, which was deemed more consistent with subacute infarct by neuro-oncology. patient was also noted to have pleural effusions, which would render her ineligible for high dose methotrexate, an commonly used to treat cns hodgkins. therefore, patient had a thoracentesis on showing a chylous effusion. cytology showed no evidence of malignant cells. the effusion reaccumulated. 3. bacteremia: patient had an episode of hypotension on and blood cultures were drawn. the culture drawn off of her picc grew vancomycin-sensitive enterococcus faecium at approximately 19 hours. her peripheral bottle grew gram-variable rods at approximately 36 hours. patient was afebrile. she was started on vancomycin and meropenem . her picc line was not pulled due to massive edema and concern for loss of access. patient's picc was pulled on and she received 4 additional days of antibiotics. surveillance blood cx remained negative. meropenem was restarted on given concern for cellulitis 4. hyponatremia with hyperkalemia: on presentation to micu, patient's sodium level was 114. she appeared mildly symptomatic from her hyponatremia with mental status changes (presumably different than her baseline), but it appeared to have been a somewhat slow decline to 114. she did not have any concerning ekg findings. given her history of high-dose steroids and possibly quick taper to 10mg of prednisone daily in order to start methotrexate, adrenal insufficiency was considered and high-dose stress steroids were administered without effect. cortisol level before steroid administration was wnl. hypovolemic hyponatremia, paraneoplastic syndrome/siadh, thyroid disease, and hypervolemia from her lymphedema (though this has been long-standing and na+ is new), were all considered. she was on a fluid restriction and reportedly on diuretics (furosemide + metolazone?) at outside facility, so hypovolemia was considered the most likely scenario and she was continued on fluid resuscitation with good result and na+ increase at the appropriate rate of 0.5meq/hr. as she was volume resuscitated, her urine electrolytes of urine na+<10 seemed to indicate appropriate sodium avidity and subsequent appropriate adh release. she continued to improve back to her baseline on mid to high 120s with more volume. tsh known to be slightly elevated prior to admission, with recent increase in her levothyroxine dosing. after beginning chemotherapy with avd, patient was again found to be hyponatremic. a renal work-up was negative for hydronephrosis and again demonstrated sodium avidity with una <10, making appropriate adh in the setting of intravascular depletion most likely. patient received salt tabs and was started on tpn with good result. sodium returned to her baseline of high 120's-low 130's. 5. acute on chronic kidney injury: patient was found to have an acute on chronic kidney injury upon presentation. her renal function improved dramatically with iv hydration. creatinine downtrended to 0.9. the nephrology service was consulted given evidence of a 1.2g protein/creatinine ratio. the renal team felt there was no urgent indication for biopsy and that proteinuria was likely secondary to recent frequent shifts in intravascular volume causing intrinsic renal disease. patient's cr was stable at 0.7 prior to transfer to bmt. on the bmt service, cr was stable at 0.5-0.8. she then had a subsequent episode of with cr of 1.2. this was felt to be due to intravascular depletion in the setting of limited po intake and patient was started on tpn and received gentle fluids with return of cr to baseline. 6. anarsarca vs. lymphedema: patient's edema is most likely secondary to her large mesenteric lad prevented effective venous return. it is has been complicated by remarkable edema and pressure ulcers on her coccyx and along her thighs and lower extremities. her edema is likely worsened by her hypoalbuminemia as a result of mild proteinuria from her renal disease. patient's edema improved with compression bandages of lower extremities and with her first cycle of avd. an mri showed that her left supraclavicular mass was likely compressing the left subclavian vein and causing lue edema. she continued to have anasarca despite interval decrease in size of mesenteric lymph nodes after avd, and required aggressive diuresis with iv lasix. 7. ulcers and skin breakdown: patient was noted to have diffuse skin weeping, and miltiple buttock and bileral lower extremity ulcers and escars. these were felt to be related to her edema. she was followed by wound care and dermatology was consulted, who determined her lesions were unlikely to be fungal or vasculitis and did not recommend biopsy. surgery was consulted for possible debridement of necrotic escars and recommended waiting on debridement until after patient's counts have recovered from chemotherapy. patient received daily wound care. 8. hypocalcemia with hyperphosphatemia: pth was elevated at 282. it was felt that hypocalcemia may have been exacerbated by low vitamin d and phosphate retention and precipitation in setting of acute renal failure dehydration. her urine ca was low (0.3), suggesting appropriate renal conservation of calcium in setting of hypocalcemia. patient has been hypercalcemic in the past; unclear what her phosphate and creatinine levels were at that time. she was started on weekly vitamin d iu and her electrolytes were repleted as needed. 9. hypothyroidism: patient's tsh was slightly elevated at 5.4 on presentation. free t4 was normal at 1.2. she developed hypothermia and was found to have tsh of 11 and low ft4, so endocrine was consulted and she was started on iv levothyroxine, absorption of po levothyroxine may have been impaired by gut edema. 10. adrenal mass: patient was noted to have a 2.5 cm adrenal mass, stable in size from to . morning cortisol was not low. dheas, testosterone, 17-oh progesterone, and shbg were wnl. a cortisol stimulation test was normal. given lack of endocrinologic laboratory abnormalities, mass may represent lymphoma. consider referral to an endocrinologist upon discharge. 11. narcotics/chronic pain: throughout admission, patient often requested additional pain medications in spite of oversedation. her medications were titrated to a combination regimen of both short and long acting oxycodone, with good reported pain control. patient's daughter approached rn to share concerns that her mother was abusing narcotics and had been addicted to narcotics for many years. on , patient was observed by her nurse hiding her morning oxycontin dose in a pill bottle, and her nurse found 2 additional oxycontin pills in the bottle. thereafter, patient was observed taking all narcotics doses. 12. small bowel obstruction: patient developed a small bowel obstruction of unclear etiology. she had no history of abdominal surgery and ct failed to reveal obstructive masses, though exam is limited. ng tube was placed for decompression and she was placed on bowel rest. 13. hypernatremia: patient developed hypernatremia, likely due to gastrointestinal losses (from small bowel obstruction), insensible water losses, and concomittant inability to take po fluids in the setting of clinical deterioration. patient progressively developed altered mental status and tachypnea. while there was no one clear precipitant, it is likely that she succumbed to her multiple decompensated medical problems. after discussion with her daughter and health care proxy, the decision was made to make her comfort measures only. palliative care was consulted and she received supportive care with morphine, lorazepam, and haloperidol as needed for comfort. she expired on . medications on admission: preadmission medications listed are correct and complete. information was obtained from nursing home records. 1. bisacodyl 10 mg pr hs:prn constipation 2. milk of magnesia 30 ml po daily:prn constipation 3. prednisone 10 mg po daily 4. senna 1 tab po qhs 5. miconazole powder 2% 1 appl tp 6. heparin 5000 unit sc tid 7. pravastatin 40 mg po hs 8. ondansetron 4 mg po bid:prn nausea 9. polyethylene glycol 17 g po daily 10. acetaminophen 650 mg po q 8h 11. guaifenesin ml po q6h:prn cough 12. sodium chloride 1 gm po bid 13. ondansetron 4 mg po qam 14. levothyroxine sodium 162.5 mcg po daily 15. oxycodone sr (oxycontin) 30 mg po qhs 16. oxycodone sr (oxycontin) 20 mg po qam 17. nystatin 500,000 unit po qid 18. folic acid 1 mg po daily 19. famotidine 20 mg po daily 20. lorazepam 0.25 mg po bid:prn anxiety 21. hydromorphone (dilaudid) 2-4 mg po q4h:prn pain 22. gabapentin 100 mg po hs discharge medications: n/a discharge disposition: expired discharge diagnosis: hodgkin lymphoma discharge condition: expired discharge instructions: n/a followup instructions: n/a procedure: spinal tap incision of lung parenteral infusion of concentrated nutritional substances biopsy of bone marrow injection or infusion of cancer chemotherapeutic substance central venous catheter placement with guidance diagnoses: hyperpotassemia urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia unspecified acquired hypothyroidism depressive disorder, not elsewhere classified candidiasis of mouth chronic kidney disease, unspecified ulcer of other part of foot unspecified disorder of adrenal glands cellulitis and abscess of leg, except foot bacteremia disorders of phosphorus metabolism hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use pressure ulcer, lower back secondary hyperparathyroidism (of renal origin) hyperparathyroidism, unspecified streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] encounter for palliative care pressure ulcer, heel hydronephrosis opioid abuse, unspecified unspecified intestinal obstruction urinary incontinence, unspecified leukocytosis, unspecified pressure ulcer, ankle volume depletion, unspecified ulcer of other part of lower limb pressure ulcer, stage ii other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms nutritional marasmus ulcer of calf other fluid overload nephrotic syndrome with unspecified pathological lesion in kidney pressure ulcer, unstageable other specified forms of effusion, except tuberculous other drug-induced pancytopenia 

Answer: The patient is high likely exposed to