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: codeine / bactrim ds / clindamycin / cephalosporins / vancomycin / aspirin attending: chief complaint: presyncope major surgical or invasive procedure: dual chamber pacemaker implantation history of present illness: ms. is an 87 year-old woman with a history of diastolic chf who was initially admitted with dizziness and shortness of breath. patient states that she was in her normal state of health until early yesterday morning when she woke up to use the bathroom. she felt like she was "teetering on water" when sitting on the side of her bed and putting her socks on. she tried to walk to the bathroom but needed to sit down in a chair so she would not fall. she called her lifeline and they responded and transported her to the ed. the patient was + for nausea. she denied cp and sob. . she does admit to orthopnea (sleeps on two pillows) but not pnd. +le edema. . in the ed, initial vitals were t: 98.4, bp 158/63, p 56, r 18, o2 97% on 4 l (89% on ra), and she was nauseated. her ecg showed ste in v1 and st depressions in v4-v6. she was given asa and zofran and was started on a nitro gtt and heparin gtt. she had a cxr which demonstrated instersitial edema and had a bnp of 1000. she was then admitted to 3, where she was felt to be fluid overloaded and she was with furosemide 20mg po x 1 and had 2725ml of urine output. . ros: the patient denies any fevers, chills, vomiting, diarrhea, palpitations, chest pain, shortness of breath, urinary frequency, urgency, dysuria, focal weakness, vision changes, headache, rash or skin changes. patient endorses constipation, which is unchanged from prior. past medical history: -head injury s/p fall (), was in coma, cerebral hemorrhage and temporary shunt/r frontal craniotomy at that time, seizure disorder since - usual seizures are "few minutes of l face tightening" with immediate return to baseline; occur 1-2x/yr -clbp related to lumbar stenosis and degenerative disease, associated polyradiculopathy by mri -"possible cervical stenosis" per dr. /neurology -polyneuropathy, per notes and per family, unknown etiology -h/o falls gait disturbance (post-cerebral hemorrhage) -htn -chf (ef 45-50% in ) -hx diverticulitis in past -arthoscopic knee surgery -depression -constipation -h/o rle cellulitis on bactrim and keflex - chronic leg edema/ rt leg ulcer social history: the patient lives home in the same house with her son, but lives on a separate floor. son and his family assist patient with adl's. ambulates with assistance of . not able to navigate stairs. not a current smoker, but used to smoke many years back; quit over 25 years ago. family history: non-contributory physical exam: physical exam: vitals: t: 96.3, bp 130/72, p 48, r 18, 95% on 2l. gen: well-appearing, well-nourished, no acute distress heent: perrl, op clear neck: no jvd, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline, no appreciable jvd cor: rrr, +systolic murmur, fixed split s2, radial pulses +2 pulm: crackles diffusely abd: soft, nt, nd, +bs, no hsm, no masses groin: ext: 1+ edema to calves bilaterally, l>r neuro: alert, oriented to person, place, and time. cn ii ?????? xii grossly intact. moves all 4 extremities. strength 5/5 in upper and lower extremities. patellar dtr +1. plantar reflex downgoing. no gait disturbance. no cerebellar dysfunction. skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses. pertinent results: 05:44am blood wbc-5.4 rbc-4.10* hgb-12.2 hct-37.9 mcv-93 mch-29.9 mchc-32.3 rdw-13.4 plt ct-174 08:00am blood wbc-11.2* rbc-3.81* hgb-11.5* hct-34.9* mcv-91 mch-30.2 mchc-33.0 rdw-14.2 plt ct-117* . 04:00am blood glucose-141* urean-29* creat-1.0 na-131* k-5.8* cl-100 hco3-19* angap-18 05:44am blood glucose-101 urean-29* creat-1.0 na-139 k-4.5 cl-100 hco3-31 angap-13 08:00am blood glucose-90 urean-46* creat-1.0 na-141 k-4.5 cl-108 hco3-23 angap-15 08:00am blood calcium-9.4 phos-2.8 mg-2.1 . 05:44am blood alt-22 ast-22 alkphos-83 totbili-0.4 07:14am blood pt-12.7 ptt-23.6 inr(pt)-1.1 . 04:00am blood ck(cpk)-115 03:28pm blood ck(cpk)-102 09:15pm blood ck(cpk)-178* 06:55am blood ck(cpk)-186* 05:05pm blood ck(cpk)-809* 10:40pm blood ck(cpk)-720* 07:34am blood ck(cpk)-730* 08:00am blood ck(cpk)-55 . 04:00am blood ck-mb-4 ctropnt-0.02* probnp-1041* 01:00pm blood ck-mb-7 ctropnt-0.20* 06:58pm blood ck-mb-6 ctropnt-0.12* 06:55am blood ck-mb-8 ctropnt-0.03* 05:05pm blood ck-mb-24* mb indx-3.0 ctropnt-0.04* 10:40pm blood ck-mb-21* mb indx-2.9 ctropnt-0.06* 07:34am blood ck-mb-21* mb indx-2.9 ctropnt-0.03* 08:00am blood ck-mb-notdone ctropnt-<0.01 . echo from : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is moderately depressed (lvef ~35-40 %) with inferolateral hypokinesis; views are technically suboptimal for assessment of regional wall motion. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). the left ventricular inflow pattern suggests impaired relaxation. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. echo repeated post pacemaker from : showed no pericardial effusion . cxr : impression: unchanged mild interstitial prominence, most consistent with fluid overload. . cxr : impression: left-sided dual lead pacer with leads in satisfactory position. severe scoliosis with leftward deviation of the mediastinum. no pneumothorax. . ecg on : sinus bradycardia with left bundle branch block . ecg on : sinus bradycardia with sinus arrest and pauses of approximately 1.5 to 2.0 seconds. left bundle-branch block and diffuse t wave inversions and repolarization abnormalities persist. compared with prior tracing of multiple abnormalities persist. however, sinus pauses are new. . ecg on : sinus rhythm. intraventricular conduction delay of the left bundle-branch block type. since the previous tracing of the rhythm is now sinus and st-t wave abnormalities are more marked. brief hospital course: 87 year-old female with h/o chf who initially presented with presyncope and was found to be volume overloaded. transferred to the ccu for bradycardia with multiple asymptomatic long pauses on telemetry while sleeping, now s/p pacemaker placement, now s/p severe drug reaction. . # bradycardia: the pt was transferred to the ccu for sinus bradycardia of 30s-40s with junctional escape beats. pt has had multiple episodes of bradycardia associated with decreased blood pressure. her hr decreased to 20s with sbp of 80s while sleeping but would icrease to hr 50s and bp 120s when awakened. she did not experience any symptoms during her episodes, though it is possible that her bradycardia contributed to the presyncopal episode for which she originally presented. on the night prior to pacemaker placement the patient had several prolonged pauses of 9 seconds associated with transiently diminished blood pressure. the patient was sleeping comfortably during these pauses. the patient was monitored on telemetry and did not experience any complications during the placement of the dual chamber pacemaker. post pacemaker she had a normal echo and pa/lateral cxr showing appropriate placement of pacer. . # cad: the pt was found to have either acute or subacute coronary disease based on new echo findings of mild lvh, ef of 35-40% (previously 70%), inferiolateral hypokinesis, 2+ mitral regurgitation, and diastolic dysfunction. she did have a troponin bump from 0.12 -> 0.20 -> 0.02. after discussion with the patient and the son it was decided to treated her medically rather than to have her go to the cath lab. she was started on an asa and a statin which was later discontinued in the context of her drug allergy reaction (see below). as per allergy the patient should never be started back on asa. later in her admission she had + cpks and + troponins which were thought to be due to the steroids as her mb index was never > 3. the patient was on lisinopril at home which can be restarted as an outpatient. please restart all medications one at a time due to her drug reaction while in the hospital. . # acute on chronic diastolic and systolic congestive heart failure: the patient was given lasix and diursed 2-3 liters. the patient has chronic swelling of lower extremities (generally in ankles) with l > r which improved with her diuresis. she did have some ankle swelling on the day of discharge. the patient's lungs are now clear to auscultation and she does not require oxygen. please continue to weigh patient daily, fluid restrict her to 1500cc, and give her a low sodium diet. . hypotension/drug allergy: on , the day after her pacemaker was placed she developed hypotension (72/32), nausea, and eventually diffuse erythema across her abdomen. an ecg was done showing she was a paced at 60 with her baseline lbbb, a stat tte showed no pericardial effusion, and her pa/lateral cxr showed normal placement of pacer. she was started on diphenhydramine and methyprednisolone, and her keflex was discontinued as it was thought she had a drug reaction. clindamycin was started as an alternative antibiotic prophylaxis s/p pacemaker. the next day, the pt became hypotensive again (78/40s) with nausea, epigastric burning, itching, diffuse body erythema, and a blister on her chest. she and was bolused ns, given iv solumedrol, iv benedryl, iv pepcid. her sbps improved to the 90s and she was transferred back to the unit for closer monitoring. all possible offending agents were discontinued including asa, simvastatin, bb, colace, senna, zofran, and all heparin products. the following day, the patient was noted to have oral and labial lesions on exam with oral pain and was seen by allergy who felt asa, cefazolin, vancomycin, or clindamycin could have been the cause. the patient had prior rash with clindamycin so the reaction could have been partly due to clindamycin in conjunction with one of the other medications. allergy placed the patient on solumedrol 60mg iv bid, dyphenhydramine, and famotidine. the patient was monitored closely with concern for syndrome. at the time of discharge she was less erythematous. she was discharged on famotidine 20 po bid, zyrtec 10mg po qhs, and solumedrol 60mg po daily until the with the following taper: 50mg po daily, 40mg po daily, 30mg po daily, 20mg po daily, 15mg po daily, 10mg po daily, 7.5mg po daily, 5 mg po daily, 2.5mg po daily, and done. please do not begin taper unless lesions in mouth and around lips have resolved. if the patient develops any worsening rash, you have any questions about the above taper, or any allergy concerns please call dr. office at . . # presyncope: likely multifactorial in setting of bradycardia with hypotension. pt now has pacemaker in place. . # seizure disorder: the pt has been on carbamazepine for years but it was discontinued here in the setting of her allergic reaction. she should be put back on this medication by her primary care physician after being restarted on her lisinopril. please space out when restarting any medications on her so that she can be observed for a drug reaction. . # fen: continue calcium, vitamin d, and multivitamins . # thrombocytopenia: the pt received heparin products while in the hospital but all products were discontinued after her drug reaction. her platelets were 208 on admission and were 117 on the day of discharge. she should avoid all heparin products in case her allergic rxn could have been hit. . # code: full medications on admission: carbamazepine 200mg daily lisinopril 10mg daily caltrate-600 plus vitamin d3 centrum silver daily tums 500mg qhs discharge medications: 1. multivitamin po daily 2. acetaminophen 325 mg po q6h as needed. 3. insulin lispro 100 unit/ml solution sig: per sliding scale subcutaneous before meals: sliding scale: if blood sugars: 0-80: 4 oz of juice 80-150: no insulin 151-200: 2 units 201-250: 4 units 251-300: 6 units 301-350: 8 units > 350: 10 units and call provider. . 4. prednisone 20 mg tablet three (3) tablet po daily. 5. famotidine 20 mg po twice a day. 6. zyrtec 10 mg po at bedtime. 7. sarna sensitive 1 % topical three times a day: for rash to treat itch. 8. caltrate-600 plus vitamin d3 600-400 mg-unit tablet sig: one (1) tablet po twice a day. discharge disposition: extended care facility: at discharge diagnosis: primary: sinus node dysfunction coronary artery disease chronic diastolic heart failure allergic drug reaction secondary: spinal stenosis discharge condition: good. ambulating without assist. tolerating oral medication and nutrition. discharge instructions: you were admitted to with nausea and dizziness. you had some fluid overload and a slow heart rate. you received a pacemaker for the slow heart rate and likely had a reaction to one of the antibiotics that were started because of the pacemaker. this allergic reaction caused a severe rash that was treated with iv prednisone, famotidine and benedryl. you will be weaned off the prednisone slowly over the next 10 days. you should avoid taking clindamycin, vancomycin, cephlosporins or aspirin as one of these medications caused the rash. . your heart is weaker now than it was in the past. you have been retaining fluid because of this and should watch for swelling or trouble breathing. weigh yourself every morning, md if weight > 3 lbs or if you notice swelling in your legs or trouble breathing. adhere to 2 gm sodium diet fluid restriction: 1500cc or about 7 cups of fluid per day. followup instructions: primary care physician: : , m.d. phone: date/time: 10:40 provider: , m.d. phone: date/time: 4:40 . cardiology: provider: . phone: date/time: 10:00 . device clinic:provider: clinic phone: date/time: 11:00 . neurosurgery: provider: , md phone: date/time: 9:00 procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: other iatrogenic hypotension thrombocytopenia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension depressive disorder, not elsewhere classified constipation, unspecified epilepsy, unspecified, without mention of intractable epilepsy sinoatrial node dysfunction accidents occurring in residential institution acute on chronic combined systolic and diastolic heart failure other drugs and medicinal substances causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to