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: heparin agents attending: chief complaint: r flank pain major surgical or invasive procedure: ir embolization endotracheal intubation blood transfusion hemodialysis l knee arthrocentesis history of present illness: for full h&p please see admission note. briefly, this is a 40m with h/o htn, aortic dissection in s/p valve on coumadin, who presented to osh approx 1 week ago with fatigue and r flank pain, found to have right rp perinephric bleed. was transferred to , stabilized with ffp and ir embolization, with stable hcts. subsequently developed atn with cr 6.0 and progressive volume overload requiring intubation and cvvh. with improved cr and uop, the patient was successfully extubated. he develop a r pleural effusion, which is not tappable per ir. the patient was transferred out of the ticu by urology to the medicine service for further management of anticoagulation (currently on heparin gtt, therapeutic x 48hours with stable hcts). per urology there is right sided renal mass which does not require inpatient work-up at this time. for hypertension the patient had been treated with labetalol, with spb 120-160s). patient currently feel well, no chest pains or shortness of breath, minimal () pain in his right flank. he can 'feel water on my lungs' but doesnt feel short of breath or have a cough. he is most concerned about getting home to his family at this point. past medical history: ascending aortic dissection s/p repair with st jude's valve (), transient hd during time of dissection, htn . social history: married, has 3 children. occasional etoh, denies tobacco family history: mother, father with hypertension, sister with cva physical exam: vs 100.7 84 149/66 92-93% on 2l 16 gen: pleasant gentleman in nad heent: ncat mmm anicteric neck: r dialysis cath in place, dressing c/d/i chest: l subclavian line removed, dressing c/d/i. decreased breath sounds b/l r>l, no wheezes, rhonchi or rales cv: rrr s1s2 prominent click c/w prosthetic valve, 2/6 sem at rusb abd: +bs slightly distended but nontender, no hsm gi/gu: no cva tenderness ext: warm, well perfused 2+dp pulses skin: no visible ecchymoses, rashes pertinent results: 10:00pm pt-26.7* ptt-26.5 inr(pt)-2.7* 10:00pm plt count-246 10:00pm neuts-92.3* lymphs-4.8* monos-2.2 eos-0.3 basos-0.3 10:00pm wbc-10.1 rbc-3.81* hgb-11.2* hct-31.6* mcv-83 mch-29.3 mchc-35.4* rdw-14.4 10:00pm estgfr-using this 10:00pm glucose-140* urea n-40* creat-2.4* sodium-135 potassium-7.4* chloride-108 total co2-19* anion gap-15 mra kidney 1. abdominal aortic dissection, extending into the proximal superior mesenteric artery and celiac axis. 2. slow flow in the narrowed right renal artery, supplied by retrograde flow in the small aortic false lumen. right kidney has been embolized. widely patent left renal artery. 3. large right renal upper pole mass. though no intravenous contrast could be administered, appearances are suspicious for renal cell carcinoma. slight intravoxel fat may suggest clear cell etiology though large size without regions of necrosis also suggests chromophobe. 4. extensive retroperitoneal and subcapsular hemorrhage extending from the right kidney. 5. probable cholelithiasis. mri renal: 1. large 13-cm mass arising from the right renal upper pole. increased heterogeneity suggests interval central necrosis possibly due to prior embolization procedure or hypoperfussion in the setting of prior hypovolemia and renal bleed. the differential diagnosis includes a chromophobe renal cell carcinoma or an oncocytoma. a papillary renal cell carcinoma is considered less likely. signal characteristics are not typical of a clear cell carcinoma. no renal vein invasion or lymphadenopathy. 2. hemorrhagic 4 cm cortical lesion arising from the right renal lower pole. given the distribution of the retroperitoneal hemorrhage, this lesion is the likely source. since prior embolization could explain the minimal to no enhancement, a neoplasm is not excluded. the differential diagnosis includes hemorrhagic cyst, renal cell carcinoma, and cortical infarct. 3. evolution of the right perinephric and retroperitoneal hemorrhage, without increase in extent. 4. two hemorrhagic left renal cysts. several additional tiny left renal cysts containing proteinaceous or hemorrhagic material. 5. aortic dissection extending into the superior mesenteric artery and both common iliac arteries. the right renal artery arises from the smaller right lumen. 6. moderate right pleural effusion. 7. small splenic lesion, likely a hemangioma. 05:10am blood wbc-5.4 rbc-3.11* hgb-8.6* hct-25.6* mcv-82 mch-27.8 mchc-33.7 rdw-14.4 plt ct-221 brief hospital course: # icu course: post-ir embolization, the patient was admitted and monitored in the icu. he remained on heparin drip for anticoagulation. his creatinine rose to 6 and potassium remained elevated. renal consult was called and suggested iv fluids and lasix. however given aggressive fluid rescucitation and acute renal failure he developed fluid overload and respiratory distress, requiring intubation and cvvh. this occurred over the course of 2 days, with resolution of hyperkalemia and decrease of creatinine. this also improved his hypertension, however he continued to run in sbps of 180s. the patient was also noted to have a right pleural effusion, but on ultrasound did not appear large enough to tap. once extubated, hemodynamically stable and no longer requiring cvvh, he was transferred to the medicine service on heparin drip for further anticoagulation and management. . # coagulopathy: on arrival to the medicine service, the patient was on a heparin drip only, yet his inr was elevated to 2.7. the cause of this remained unclear but it was thought to be secondary to acute liver injury, given his elevated enzymes on admission that were slowly resolving. he was given a 2mg dose of vitamin k to which he responded appropriately. coumadin was initially held for thoracentesis and potential for other procedures but was eventually started with heparin bridge. the patient was discharged with an inr of 2.5; he has an appointment on monday (day post-) for repeat inr check and coumadin dose adjustment. . # acute renal failure: the patient had some underlying renal insufficiency (cr 1.6-1.7 at baseline) before the acute hemorrhagic insult. his creatinine and bun were trended, nephrotoxins were avoided when possible, and the renal service was consulted for recommendations on treatment and restarting anti-hypertensives. his creatinine improved significantly, and prior to dischage returned to his baseline of 1.5. he will be seen by the renal service as an outpatient. . # anemia: this was felt to be due to both his hemorrhagic insult as well as anemia of chronic disease given his chronic renal failure. he maintained a stable hematocrit of 22 for some time. in the setting of improved blood pressure control, he was given a one-time dose of epogen to which he responded with a hematocrit of 24. this was short-lasting, and several days later he returned to hct 22. at that point (again, with improved blood presures) he was transfused with 1u prbc and hct jumped to 27. his iron studies were normal (except for ferritin which was elevated in the setting of acute illness). his hematocrit was monitored and remained stable for the remaineder of his admission. . # hypertension: on transfer to the medicine service, the patient's blood pressure ran 160-200/40-60s. he was continued on carvedilol, and several other agents were added during the course of his stay including amlodipine, lasix, hydralazine, clonidine patch and lisinopril. with improvement in his renal function, we slowly removed hydralazine and clonidine from his regimen with good response. lisinopril was added on last but caused an acute jump in his creatinine from 1.9 to 3.0. on removal his creatinine returned to baseline. his blood pressure was well controlled and prior to lisinopril was restarted at low dose (5mg daily). his blood pressure should be maintained in goal range of 120-130s in the setting of dissection. . # respiratory failure/pleural effusion: the right pleural effusion was noted on cxr during his icu stay. initially afebrile, the patient had several fever spikes (max 102.3) which prompted a thoracentesis and addition of vancomycin and zosyn for hospital acquired and vent-acquired pneumonia. his fevers resolved for several days, then returned at low grade despite antibiotics. at that time it was felt that the origin could have been from his abdomen. coverage was switched to levofloxacin and flagyl for a 2 week course. his thoracentesis was consistant with an exudative effusion, however it was not felt this was an empyema. he remained afebrile and did not require supplemental oxygen for the remaineder of his stay. last day of antibiotics is . he should have a repeat chest xray done within several weeks after to ensure resolution of pleural effusion. . # renal mass: the patient had multiple imaging modalities to evaluate the mass, however it is still unclear as to the etiology. there are two separate massess noted, the larger one being on the superior pole of the kidney and a smaller one on the inferior pole. on discussion between the renal service, urology and hematology/oncology the patient will follow-up once discharged for further imaging. there is concern for multiple etiologies such as renal cell carinoma, hemorrhagic cysts, lymphoma, etc. further work-up needs to be pursued upon . a renal mri w&w/o contrast was performed. . # gout: during his admission the patient had recurrent episodes of polyarticular gout, which was confirmed by arthrocentesis of the left knee. given his renal status, it was felt that a one-time dose of prednisone may be the best way to treat his symptoms. a 50mg po prednisone dose was administered which resolved his symptoms. he had another, less painful bout of gout a week later and received another 40mg po dose of prednisone. his colchicine was restarted on . . medications on admission: coumadin 3mg daily, coreg 120mg daily, trimaterene-hctz 50-25mg daily, lotrel 10-20mg , colchicine 0.6mg daily, doxazosin 8mg daily, tricor 145mg daily medications: 1. warfarin 3 mg tablet sig: one (1) tablet po once a day. 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 5. tricor 145 mg tablet sig: one (1) tablet po once a day. 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. carvedilol 12.5 mg tablet sig: four (4) tablet po bid (2 times a day). disp:*240 tablet(s)* refills:*2* 8. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. hydrocodone-acetaminophen 5-500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. disp:*20 tablet(s)* refills:*1* 10. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. colchicine 0.6 mg tablet sig: one (1) tablet po once a day. disposition: home diagnosis: perinephric, retroperitoneal bleed acute renal failure hyperbilirubinemia anemia hypertension condition: hemodynamically stable and afebrile instructions: you were admitted to the hospital with flank and abdominal pain and found to have a bleed in your abdomen. you were treated by interventional radiology and had embolization of actively bleeding arteries. you were also treated for acute kidney failure, fluid overload with hemodialysis and intubation while you were having trouble breathing. you will require close follow-up for your blood pressure and to make sure you are further evaluated by the urology service for your kidney mass. please make sure to follow-up with your physicans (appointments scheduled below) and have your coumadin level followed each week in coumadin clinic. you need to have your coumadin checked first thing monday morning () to ensure your inr is therapeutic. over the weekend please take your 3mg coumadin pills as you did prior to your admission. for blood pressure control, your medications were changed to: amlodipine, carvedilol, and lisinopril. your primary care doctor can adjust these as needed. you can continue taking your colchicine and tricor as before. you will need to have your creatinine levels checked regularly as both of these medications may need to be adjusted based on kidney function. when you see your primary care doctor , make sure you have a repeat chest xray done to ensure resolution of the pleural effusion. if you experience abdominal or back pain, nausea/vomiting, fevers, chills, blood in the stool or urine, dizziness or lightheadedness, or any other concerning symptoms please call your doctor or return to the emergency room. followup instructions: ** please make sure to go to assoc. to have your coumadin checked on monday . provider: , , md phone: , 3:45pm provider: , md phone: date/time: 1:00 -urology appt: dr office will call you with the date and time of your next appointment within the next several days. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis thoracentesis arterial catheterization arthrocentesis closed [endoscopic] biopsy of large intestine other endovascular procedures on other vessels diagnoses: hyperpotassemia anemia in chronic kidney disease acute kidney failure with lesion of tubular necrosis unspecified pleural effusion acute posthemorrhagic anemia gout, unspecified heart valve replaced by other means acute respiratory failure unspecified disorder of kidney and ureter long-term (current) use of anticoagulants ventilator associated pneumonia acute vascular insufficiency of intestine vascular disorders of kidney hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified acute edema of lung, unspecified other specified disorders of liver chronic kidney disease, stage ii (mild) other specified cystic kidney disease 

Answer: The patient is high likely exposed to