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: patient recorded as having no known allergies to drugs attending: chief complaint: admission for liver transplant major surgical or invasive procedure: liver transplant redo arterial anastomosis ercp:stricture at the anastomotic site between the donor and recipient common bile duct with stent placement : ex lap, lysis of adhesions, small bowel resection ercp with stent removal liver biopsy history of present illness: 52-year-old male with a history of cirrhosis secondary to hcv and alcohol who developed portal hypertension and an esophageal variceal hemorrhage, necessitating performance of a distal splenorenal shunt in . last year he was found to have a 4.4-cm hepatocellular carcinoma. he has undergone chemoembolization followed by radiofrequency ablation of a segment vi lesion. a repeat ct of the abdomen and chest on demonstrated no evidence of tumor recurrence at the ablation site and no evidence of new or concerning lesions elsewhere in the liver or lungs. he is in good spirits today. no recent infections or illnesses. he has not been taking his lactulose because he has been having 2 bms a day without it. his blood sugars have been well controlled with the 68 of lantus at night. past medical history: cirrhosis secondary to hepatitis c (diagnosed ) as well as alcohol use - attempted treatment with interferon and ribavirin, but only on it for a couple of weeks at 1/3 of the normal dosage and experienced thrombocytopenia and stopped - decompensated with a variceal bleed in / - status post splenorenal shunt hepatocellular carcinoma - s/p chemoembolization on , at . - turned down for liver transplant at secondary to marijuana use. history of a right leg fracture and a left leg fracture social history: currently living with a friend and is separated from his second wife. has two children ages 7 and 24. he quit smoking two years ago but previously smoked heavily. no current alcohol use. past history of cocaine use but none recently. no history of ivdu. currently not working. family history: dad - died at age 70 of cad and cva mom - aged 83 and healthy brother and sister - both healthy denies family history of liver disease, liver cancer or colon cancer physical exam: 96.6 88 160/100 18 97ra a&ox4 no jaundice neck no lymphadenopathy lungs: ctab heart: rrr abd: soft, nt, no hernias ext: no edema skin: psoriasis patches and vitiligo on his hands pertinent results: 08:14am blood wbc-3.6* rbc-3.45* hgb-12.8* hct-35.2* mcv-102*# mch-37.0* mchc-36.3* rdw-15.3 plt ct-96* 08:14am blood pt-16.2* ptt-33.9 inr(pt)-1.4* 08:14am blood glucose-144* urean-8 creat-0.7 na-139 k-3.3 cl-109* hco3-24 angap-9 08:14am blood alt-81* ast-108* alkphos-109 totbili-1.9* 08:14am blood albumin-3.6 calcium-8.4 phos-3.7 mg-1.8 studies: bone scan - no evidence of osseous metastasis. ct torso - stable appearance of the torso. no evidence for recurrence or metastatic disease. enlarged spleen unchanged. cardiac stress test - 1. normal myocardial perfusion. no discrete defect to suggest ischemia. 2. enlarged left ventricular cavity size. estimated lvedv of 145 ml. - normal lvef of 52 %. brief hospital course: on , he underwent piggyback liver transplant; ligation of distal splenorenal shunt; lysis of adhesions. surgeon was dr. assisted by dr. . please refer to operative note. drains were placed. induction immunosuppression was given. postop, he went to the sicu. lfts increased and a liver duplex was done showing relatively slowed acceleration times and low resistive indices, with waveforms suggestive of the possibility of hepatic arterial stenosis. there was bidirectional flow within the left portal vein. a cta was then done noting marked focal kink and abrupt caliber change at the hepatic arterial anastomosis, narrowing at the portal venous anastomosis and an area of hypodensity in the liver transplant, which suggested a site of ischemia/hypoperfusion or perhaps early infarction, although the vast majority of the liver opacified normally. he was then taken back to the or on by dr. who performed excision of hepatic artery atheroma, with revision and reanastomosis for hepatic artery stenosis and liver biopsy. postop, he was sent to the sicu where he was extubated. lfts trended down. he was started on prograf on as well as cellcept and steroid taper. liver duplex on showed improved flow within the hepatic arteries, with prompt systolic upstrokes, hepatopetal flow in the main and right portal veins. flow in the left portal vein was hepatopetal, but slow and intermittent; however, to and fro flow in the left portal vein was no longer observed. there was a right pleural effusion. he was transferred out of the sicu on where his diet was advanced. pain was hard to control requiring higher doses of dilaudid (6mg prn q 3 hours). lfts increased on and again on witih t.bili increasing to 6.7 on . duplex of the liver revealed patent main, left and right portal veins with normal hepatic veins and hepatic arteries. there was no biliary dilatation or ascites. on , an ercp was done with a stricture at the anastomotic site between the donor and recipient common bile duct, with mild extravasation of contrast seen at that site. a plastic biliary stent was placed. he tolerated this procedure well with subsequent downward trend of all lfts. ercp was repeated on as his lfts were trending upwards with alk phos at 715. the plastic stent placed in the biliary duct with previous ercp was found in the major papilla. a sphincterotomy had not been performed at the initial ercp. given the new pancreatic duct dilation on ct a sphincterotomy was performed over the stent in the 12 o'clock position using a needle-knife. a new biliary stent was placed and the patient was started on ursodiol. due to pain control issues, he was being given morphine and dilaudid with moderate relief of pain. he continued to complain of abdominal pain and developed abdominal distension. an abdominal ct on showed improved small-bowel obstruction with transition point in the mid right abdomen compared to , although there was distention of mid small bowel loops with respect to the distal small bowel. there was decreased small amount of fluid with locules of air along the liver transplant bed. previously noted pancreatic ductal dilatation was improved. daily kubs demonstrated decreased small bowel distension. abd ct was repeated on showing patent transplant vasculature with caliber change in the hepatic artery at the anastamosis due to size mismatch and partial small bowel obstruction. due to rising lfts, a liver biopsy was performed on with changes consistent with moderate acute cellular rejection with centrivenulitis,mild cholestasis. there was no biliary necrosis or obstruction. he was enrolled in the prograf study which involved treating rejection with higher trough prograf levels. prograf levels were high at that time (22 on ) already due to diarrhea that he was experiencing. prograf was adjusted achieving goal trough levels of 14-18. cellcept which had been decreased to 250mg qid due to gi intolerance was increased to 500mg qid. lfts trended down each day. although, he did experience a rising creatinine with creatinine increasing to 3.5 on likely due to prograf. on , he was taken to the or for laparoscopy for persistent complaints of abdominal pain. surgeon was dr. . he underwent exploratory laparotomy, lysis of adhesions and small bowel resection with primary anastomosis. a twist in the bowel and a stitch was which was tenting up the omentum was noted causing the twist in the bowel. vancomycin and zosyn were given for 48 hours postop. ng was removed and diet was gradually resumed, but he developed diarrhea and complaints of abdominal discomfort. on , he was febrile to 101. blood and urine culture were sent with growth of gram negative rods on blood cultures. the picc line was removed and tpn stopped. cefepime and flagyl were started on . abd ct was done on showing new small bowel wall thickening possibly representing infectious or inflammatory process. air in the bladder 1 week after removal of foley catheter was concerning for cystitis. there as also new small amount of ascites. cefepime and flagyl were continued and cellcept was decreased to 250mg on . diarrhea resolved. a picc line was inserted on and tpn was resumed. of note, the picc tip culture was negative as well as urine and stool for c.diff. on , alk phos was increased to 606 from 552 and t.bili increased to 4.2 from 2.3. an ercp was performed noting mismatch donor/recipient size otherwise there was no leak/stenosis and the stent was removed. alk phos continued to trend up after the ercp. on , a liver biospy was performed showing resolving rejection. there were biliary centric features concerning for an infectious vs obstructive/ischemic process. viral stains were done. a cmv viral load was sent and is negative, as well as an hcv vl which is reported as 8,400,000 iu/ml. remeron was stopped due to potential to affect lfts as was bactrim. pentamadine was not started and this will need to be addressed at outpatient clinic. cefepime was stopped on . flagyl is due to be completed . patient had calorie counts done which were very variable (700->). patient discharged to home with vna for medication teaching, blood glucose management and monitoring the abdominal incision (staples are d/c'd) medications on admission: lantus insulin 68 units in the evening humalog sliding scale mirtazapine 50 mg. tab at night for sleep discharge medications: 1. fluconazole 200 mg tablet sig: two (2) tablet po q24h (every 24 hours). 2. valganciclovir 450 mg tablet sig: two (2) tablet po daily (daily). 3. ursodiol 300 mg capsule sig: two (2) capsule po bid (2 times a day). 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po once a day. 5. prednisone 5 mg tablet sig: 2.5 tablets po daily (daily). 6. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po qid (4 times a day). 7. loperamide 2 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*60 capsule(s)* refills:*0* 8. tacrolimus 1 mg capsule sig: one (1) capsule po twice a day. 9. insulin nph human recomb 100 unit/ml suspension sig: forty (40) units subcutaneous once a day: am dose. 10. insulin nph human recomb 100 unit/ml suspension sig: twenty eight (28) units subcutaneous once a day: pm dose. disp:*2 bottles* refills:*2* 11. insulin lispro 100 unit/ml solution sig: per sliding scale subcutaneous four times a day: before meals and bedtime. 12. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 2 days. disp:*5 tablet(s)* refills:*0* 13. tacrolimus 5 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: hcv s/p liver transplant hepatic artery stenosis stricture at the anastomotic site between the donor and recipient common bile duct, dm ileus partial small bowel obstruction liver rejection bile leak diarrhea depression malnutrition discharge condition: good discharge instructions: please call the transplant office if fever, chills, nausea, vomiting, inability to take any of your medications, abdominal pain, diarrhea or any concerns take loperamide for management of frequent/loose stool. if you are starting to get constipated, stop the loperamide. take colace if you becoming constipated labs every monday and thursday no driving if taking narcotic pain medication shower check blood sugar prior to meals and bedtime. now on nph and humalog for glucose management. please follow up with followup instructions: , md phone: date/time: 10:00 ercp 2 (st-4) gi rooms date/time: 1:00 , md phone: date/time: 1:00 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other partial resection of small intestine other revision of vascular procedure closed (percutaneous) [needle] biopsy of liver closed (percutaneous) [needle] biopsy of liver endoscopic sphincterotomy and papillotomy other surgical occlusion of vessels, abdominal veins endoscopic insertion of stent (tube) into bile duct other lysis of peritoneal adhesions other lysis of peritoneal adhesions removal of t-tube, other bile duct tube, or liver tube open biopsy of liver endoscopic retrograde cholangiopancreatography [ercp] replacement of stent (tube) in biliary or pancreatic duct other operations on lacrimal gland transplant from cadaver auxiliary liver transplant diagnoses: chronic hepatitis c without mention of hepatic coma alcoholic cirrhosis of liver acute kidney failure, unspecified unspecified protein-calorie malnutrition portal hypertension depressive disorder, not elsewhere classified accidental puncture or laceration during a procedure, not elsewhere classified bacteremia peritoneal adhesions (postoperative) (postinfection) diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled complications of transplanted liver personal history of malignant neoplasm of liver surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation obstruction of bile duct unspecified intestinal obstruction volvulus other specified bacterial infections in conditions classified elsewhere and of unspecified site, other anaerobes atherosclerosis of other specified arteries 

Answer: The patient is high likely exposed to