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: gluten attending: chief complaint: free air major surgical or invasive procedure: egd x2 exlap, small bowel resection x2 with primary reanastamosis exlap, small bowel resection, jejunal stoma formation, mucous fistula formation for anastomotic breakdown percutaneous cholecystostomy tube placement percutaneous drainage of perihepatic fluid collection bilateral chest tube placement history of present illness: mr. is a 61 m with a medical history notable for celiac disease. of note, he was recently admitted to from to for worsening gi symptoms thought to be related to his difficult-to-control celiac disease. he was started on budesonide, loperamide, and tpn. an endoscopy performed during that admission revealed duodenitis. he reports feeling well at dischcarge on the tpn and was even able to travel on . however, approximately 3 weeks ago he noted marked fatigue and dyspnea on exertion. he is currently very weak and unable to perform basic activities around his house. his abominal cramping has also increased and his diarrhea has returned. his bowel movements are "muddy" with rare bright red blood (usually with straining), but no melena. no nsiads or recent alcohol use. since discharge he was started on prednisone and started on mercaptopurine on . he was seen in clinic on . after his routine laboratory studies returned with worsening anemia he was referred to the ed. vital signs on arrival to ed: t 98.2, p 100, bp 129/76, 100% ra. his evaluation in the ed was notable for a hct of 22.5, guaiac positive stool, and a negative gastric lavage. in the ed he received pantoprazole 40mg iv, morphine, 1 unit of packed red blood cells, and iv fluids. on he underwent egd showing friable duodenal mucosa with contact bleeding. since the procedure he has had worsening abdominal pain, and was found to have copious free air on cxr and kub. we were contact to evaluate him for possible perforation. past medical history: hypertension celiac disease diagnosed in after work-up for osteoporosis social history: patient lives with his wife. is a retired history teacher. he has two children. patient reports smoking a pipe occassionally and previously drank wine on occasions but none recently. family history: he is adopted and has no family history of sprue of which he is aware. has two healthy children. physical exam: vital signs: t 99.3, p 83, bp 132/83, 96% on ra. current pain . physical examination prior to egd by gi on : - gen: thin male, appears chronically ill. - heent: pale conjunctiva. oropharynx clear w/out lesions. - chest: normal respirations and breathing comfortably on room air. lungs clear to auscultation bilaterally. - cv: regular rhythm. normal s1, s2. no murmurs or gallops. jvp <5 cm. - abdomen: normal bowel sounds. he is diffusely tender throughout his abdomen with no rebound or guarding. - extremities: 1+ ankle edema to the knees bilaterally. - skin: no lesions, bruises, rashes. - neuro: alert, oriented x3. good fund of knowledge. able to discuss current events and memory is intact. cn 2-12 intact. speech and language are normal. - psych: appearance, behavior, and affect all normal. upon surgical evaluation after the egd: 96.8 127 128/74 22 99% 2l uncomfortable, anxious no respiratory distress abdomen distended, tympanytic +rebound +guarding no scars, no hernias pertinent results: 09:44am wbc-20.6* rbc-3.01*# hgb-8.0*# hct-25.8*# mcv-86 mch-26.7* mchc-31.2 rdw-15.6* 09:44am neuts-95* bands-0 lymphs-2* monos-2 eos-0 basos-0 atyps-0 metas-0 myelos-1* 09:44am crp-126.1* 09:44am tot prot-4.8* albumin-2.1* globulin-2.7 calcium-7.3* phosphate-2.1*# magnesium-2.2 09:44am alt(sgpt)-37 ast(sgot)-18 ld(ldh)-183 alk phos-209* tot bili-0.6 cxr : in comparison with the study of , there is a substantial amount of free intraperitoneal gas beneath the hemidiaphragms. atelectatic change with possible effusion again seen at the right base. ctap : 1. extraluminal oral contrast seen adjacent to a loop of mid jejunum in the lower mid abdomen, presumably representing a site of small bowel perforation with resultant pneumoperitoneum and fluid in the abdomen. 2. small bowel mural thickening, presumably related to known diagnosis of celiac sprue. 3. large area of mesenteric adenopathy and 'mistiness'. this finding is unchanged since and though it may be related to reactive changes from the known celiac disease, lymphoma is another consideration and ongoing followup is recommended as per the previous study. 4. distended gallbladder pathology small bowel resection : 1) small bowel, at 110 cm, resection (a-b, q-ab): small bowel segment with multiple perforations and associated full thickness ulceration, exudative inflammation and extensive granulation tissue. adjacent intact mucosa with extensive villous blunting with increased intraepithelial lymphocytes consistent with prior history of refractory celiac disease. atypical lymphoid infiltrate, refer to part 2 for further characterization. 2) small bowel, resection (c-p, ac-aj): small bowel segment with multiple perforations and associated full thickness ulceration, exudative inflammation and extensive granulation tissue. adjacent intact mucosa with extensive villous blunting with increased intraepithelial lymphocytes consistent with prior history of refractory celiac disease. atypical lymphoid infiltrate, see note. pathology small bowel resection : small bowel, resection: 1. small intestinal segment with acute and chronic inflammation, patchy ulceration, focal anastomotic site mucosal necrosis, prominent submucosal edema, and extensive serositis; no definitive perforation identified. 2. viable margins with marked edema, focal mucosal ulceration and mild active inflammation. 3. increased intraepithelial lymphocytes, villous shortening, and crypt hyperplasia, consistent with involvement by patient's known celiac disease; paneth cells do not appear overall decreased in viable mucosal areas. see hemepath note. 4. one unremarkable lymph node. ct torso : 1. bilateral pleural effusions, increased compared with previous study. 2. diffuse anasarca and diffusely abnormal small and large bowel wall thickening consistent with mucosal edema. given the diffuse involvement this likely represents third spacing. 3. diffuse mesenteric fat stranding and mesenteric lymphadenopathy. 4. moderate amount of free fluid in the pelvis and both paracolic gutters. no discrete localized fluid collection seen however infection cannot be excluded. 5. interval formation of bilateral stomas. 6. lower abdominal wound dehiscence. 7. distended gallbladder. 8. left inguinal hernia containing fluid. ct guided percutaneous cholecystostomy tube placement : technically successful percutaneous cholecystostomy tube placement. sample sent for microbiology analysis. a total of 200 cc of dark green turbid bile were aspirated. ct guided percutaneous abdominal fluid collection drainage : technically successful aspiration and drainage catheter placement right upper quadrant ascitic fluid pocket as above. 200 cc clear straw-colored fluid were aspirated to bag. ct torso : 1. stable bilateral pleural effusions. 2. new diffuse bilateral ground glass opacities, infectious vs. aspiration. 3. thickened small and large bowel with surrounding mesenteric stranding and fluid, relatively unchanged from prior. 4. stable midline wound with interval resolution of associated free air and contrast extravasation. interval resolution of anterior abdominal fluid collection in the right upper quadrant, with interval placement of a peripherally placed percutaneous drain. gj-tube in place. 5. cholecystomy drain in place with surrounding decompressed gallbladder. 6. stable pelvic fluid collection with stable adjacent enhancement of peritoneum. ruq u/s : 1. no intrahepatic biliary ductal dilatation. 2. 3-mm cbd containing echogenic material, most likely representing sludge or pus. 3. catheter within the gallbladder, which appears collapsed. 4. no ascites. 5. right pleural effusion cholangiogram through percutaneous cholecystostomy tube : free flow of contrast into the duodenum brief hospital course: mr. is a 61 yo gentleman with severe, medically refractory celiac disease who underwent push endoscopy on with multiple biopsies. after this procedure, he developed significant abdominal pain and a chest xray and kub showed massive free air. follow up ct scan of the abdomen revealed contrast extravasation from the bowel lumen indicative of perforation. for this reason, he was taken emergently to the or on and underwent bowel resections x2 (over 160 cm of small bowel in total) with two primary reanastamoses. unfortunately, these anastamoses broke down over the ensuing days likely secondary to his baseline poor nutrition as well as the inherent friability of his intestines secondary to his severe, medically refractory sprue. he ultimately required reoperation on . during this operation, a further 20 cm of bowel were resected and a jejunal stoma as well as a mucous fistula were created. the patient continued to do poorly overall and ultimately was transferred to the icu on for respiratory distress and was intubated and later found to have developed a hospital acquired pseudomonal pneumonia. during the next 11 days, the patient developed a new fascial dehiscence with enterocutaneous fistula which was controlled with bag drainage. he also underwent percutaneous cholecystostomy tube placement for a distended gallbladder and a drain placed percutaneously into a perihepatic collection but this did little to alleviate his problems. further developed an acutely dropping hematocrit and underwent egd which showed a fresh clot but no active bleeding in his stomach. this was treated with a pantoprazole drip. concurrently, he developed worsening hepatic failure with cholestasis and a bilirubin rising to 18.0 and worsening coagulopathy indicative of liver failure. in a last ditch effort to identify a source of his sepsis and worsening organ failure, bilateral chest tubes were placed which drained serous fluid. in discussions with his family, it was decided to make him comfort measures only on . he was terminally extubated and passed soon thereafter. his hospital course is summarized below by system: neuro: his pain was controlled throughout his hospital stay on a combination of iv or po medications. at the time of his terminal extubation, he was placed on a fentanyl and versed drip to ensure sufficient treatment of his pain, dyspnea, and anxiety. cv: for most of his hospital stay, he remained, in general, hemodynamically stable. in the last days of his hospitalization, he had an ever-worsening pressor requirement and was ultimately on levophed, neosynephrine, and vasopressin at the time of his extubation. after extubation, his demise was so quick that the pressors had not yet even been turned off. pulm: for the most part, the patient did well from a pulmonary perspective. however, on transfer to the unit on , he had begun to develop respiratory failure and was intubated for hypoxemic respiratory failure thought to be secondary to pseudomonal pneumonia. he grew out numerous colonies of p. aeruginosa, most of which were resistant to numerous antibiotics. during his last few days, chest tubes were placed bilaterally to see if this would improve his pulmonary mechanics and function. after his terminal extubation, he quickly developed worsening hypoxemia and hypercarbia whereupon he passed away quickly. gi/fen: after his endoscopy, he required emergent operation for bowel perforation. at his first operation, at 7 enterotomies were discovered in two different segments of bowel starting approximately 110 cm from the ligament of treitz. these two areas of bowel (approximately 150 cm and 10 cm respectively) were resected with primary reanastamoses. initially, he seemed to have tolerated the procedure as well as could be expected. however, he soon developed serous drainage from the superior portion of his wound and it was noted that he had a developing fascial dehiscence. he went back to the or and had the intervening 20 cm of small bowel resected and the proximal end of his bowel was brought out in the llq as a jejunal stoma. the distal portion was brought out in the rlq as a mucous fistula. a gtube was also placed to help with feeds. his abdomen was again reapproximated and retention sutures were left in place. his initial high output from his jejunal stoma was treated with tincture of opium as well as immodium and psyllium wafers without much improvement in the total output. ultimately, his wound dehisced again along with the development of an enterocutaneous fistula which was controlled with a large ostomy appliance to the wound. he began growing pseudomonas from this wound as well. in addition, in order to rule out and treat other possible sources of his sepsis, he underwent percutaneous cholecystostomy tube placement as well as drainage of a perihepatic fluid collection. this proved to be futile. although earlier in his course he was able to take some pos, his gut did not appear to tolerate any enteral nutrition either through the gtube or po. the patient had been on tpn prior to his hospitalization and this was continued in house due to concern over the ability of his gut to absorb nutrition as well as over his poor nutritional status in general. his albumin levels remained low accordingly and he required lots of colloid and crystalloid resuscitation as well as blood product transfusion, when indicated, in order to maintain intravascular volume although he developed progressively worsening anasarca indicative of his overall poor nutritional status and inability to tolerate enteral feeds. in the last week of his hospitalization, as part of his overall septic picture, he started to develop worsening liver failure with elevated bilirubin, progressive coagulopathy which was complicated by an ugib as noted on repeat egd. this was treated with transfusions, vitamin k, as well as a pantoprazole drip. gu: he had a foley in place for most of his hospital stay for urine output monitoring. at some point he also grew out pseudomonas from his urine as well. this infection was treated concurrently with his pneumonia with broad-spectrum antibiotics. endo: after his initial surgery, he was given stress-dose steroids and then was tapered off the steroids completely due to concerns that they were adversely impacting his ability to heal his wounds. due to concerns for adrenal insufficiency, he underwent a cortisol stimulation test which showed a normal response in his adrenal glands. blood sugars were monitored and treated appropriately. heme: due to his many surgeries and critically ill state, the patient's white count and hematocrit were closely monitored. ultimately he had a rising white count (into the 30s) as well as a falling hematocrit. he was treated with rbcs and other blood products as necessary in order to treat his coagulopathy and bleeding-induced anemia. id: id consultation was obtained due to the patient's resistant pseudomonus found in his sputum. he was treated with various antibiotics and was ultimately placed on vancomycin, doripenem, and amikacin for his hospital acquired pna with double-coverage of the pseudomonas. medications on admission: prilosec 20mg daily prednisone 40mg daily percocet prn pain mercaptopurine 50 mg daily labetalol 50mg once daily discharge medications: expired discharge disposition: expired discharge diagnosis: primary diagnosis: celiac disease, severe type 2 multiorgan system failure secondary to sepsis pseudomonas pneumonia enterocutaneous fistula anastomotic breakdown discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other gastroscopy other partial resection of small intestine percutaneous abdominal drainage arterial catheterization colostomy, not otherwise specified closed [endoscopic] biopsy of bronchus esophagogastroduodenoscopy [egd] with closed biopsy other gastrostomy replacement of gastrostomy tube percutaneous aspiration of gallbladder multiple segmental resection of small intestine ileostomy, not otherwise specified reclosure of postoperative disruption of abdominal wall replacement of stent (tube) in biliary or pancreatic duct other biliary tract x-ray central venous catheter placement with guidance diagnoses: other postoperative infection unspecified pleural effusion unspecified essential hypertension adrenal cortical steroids causing adverse effects in therapeutic use acute posthemorrhagic anemia acute and subacute necrosis of liver unspecified septicemia atrial fibrillation accidental puncture or laceration during a procedure, not elsewhere classified paroxysmal ventricular tachycardia acute respiratory failure pneumonia due to pseudomonas surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation osteoporosis, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other specified disorders of biliary tract celiac disease other ascites hemorrhage of gastrointestinal tract, unspecified ventilator associated pneumonia other and unspecified coagulation defects empyema without mention of fistula leukocytosis, unspecified fistula of intestine, excluding rectum and anus disruption of external operation (surgical) wound attention to gastrostomy acute pyelonephritis without lesion of renal medullary necrosis accidental cut, puncture, perforation or hemorrhage during endoscopic examination 

Answer: The patient is high likely exposed to