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: liver failure major surgical or invasive procedure: liver biopsy intubation arterial line history of present illness: this is a 74 year old post menopausal nulliparous woman with recent diagnosis of endometrial cancer, uterine fibroids and left adnexal cyst who was transferred from osh for further work-up of new liver failure. patient had been admitted to hospital on for postmenopausal vaginal bleeding for 4 weeks. patient underwent a dilatation and curettage and was subsequently diagnosed with endometrial adenocarcinoma. a pelvic ultrasound also revealed a left adnexal cyst (8.8cm) and uterine fibroids. patient's ca-125 was 30.9. however during the initial admission, the patient was noted to be severely jaundiced, leading to an evaluation for liver failure. the tah was therefore placed on hold and she was transferred to for further evaluation and w/u of her liver disease. . patient denies personal or family history of hepatitis. she was in a monogomous relationship with her husband who died 13 years ago and hasn't been with anyone else since. she never used iv drugs and has never received or been exposed to any blood products (apart from 2 u ffp administered on after dx of liver dz made for considerable vaginal bleeding). . of note, patient has been on an otc pill for high cholesterol called "one a day cholesterol," since / but she d/c this med upon admission to the hospital in . she has no history of autoimmune disease and never drank etoh. no history of significant hypotension that she is aware of and she does not take tylenol. she does not eat mushrooms. she has been c/o early satiety and abd fullness for the past few days but denies any noticable weight loss. . her totabl bilirubin was found to be 15.3 with direct 9.5. alt 478 and ast 1007, alk phos 138 and ggt 47. while at the osh, she did require 2 u ffp for her bleeding. her lfts initially rose but then gradually started to decline. she underwent an abd u/s which did not show any stones or ductal dilatation. ct abd/pelvis showed a normal liver. . ros: (+) weak since admission, poor po (only really tolerating soup etc as solids cause early satiety/abd fullness), increased doe, decreased uop, f, sweats, chills, pruritis, ams, brbpr, hematemesis, n, joint pain, muscle pain, ha past medical history: past medical history: 1. endometrial cancer (dx'd by d&c recently) 2. uterine fibroids 3. left adnexal cyst seen on pelvic us and pelvic ct from osh 4. nulliparous, no history of hrt, menopause at age 45 . past surgical history: 1. status post dilatation and curettage 2. status post tonsillectomy as a child social history: no tobacco or alcohol ever. patient lives in bermuda in an apartment. her sister lives in a nearby apartment and has come with her. sister is staying at a nearby hotel. patient is a widow. she worked as an elementary teacher in the past. family history: mother: gallstones and coronary artery disease father: coronary artery disease 3 brother, 1 sister - no family history of cancer or liver disease physical exam: vs: tc: 97.6, bp: 120/71, hr: 102, rr: 20, sao2: 100% room air gen: nad, lying in bed, coughing occasionally heent: perrl, + scleral and sublingual icterus, mmm, arcus senilus cv: rrr, no murmurs/rubs/gallops pulm: clear to auscultation bilaterally, decreased breath sounds on right abd: normoactive bowel sounds, soft, nontender, +fluid wave, distended, negative , unable to palpate l adnexal mass or spleen ext: trace le edema, 2+ pt pulses bilaterally neuro: alert, ox3, cn 2-12 grossly intact, sensory intact to soft touch bilaterally, wiggles toes bilaterally, grip bilaterally, no asterixis pertinent results: labs from osh records: () t bili 15.3 (direct 9.5) -> 19.6 () () alt 478, ast 1007, alk phos 138, ggt 47 -> alt 350, ast 758, alk phos 220, ggt 45 () () creat 1.2 () hgb 10.1 (prior 14) -> 10.3 () () pt 13.8, ptt 39.4, inr 1.25 -> pt 23.1, ptt 56.7, inr 3.18 () -> 3.13 () esr 73, hep c ab neg, hep b ab, hep b core ab neg, ag haa neg, iron 20, tibc 242, sat 8% . alpha-1-antitrypsin, ceruloplasmin, cmv igg and igm, serum cu, ebv, mitochondrial ab, cea: pending . alb 2.1 () plt 167 () creat 1.5 () . serologic studies from : 05:12am glucose-78 urea n-15 creat-1.6* sodium-132* potassium-3.2* chloride-103 total co2-20* anion gap-12 05:12am alt(sgpt)-279* ast(sgot)-570* ld(ldh)-301* alk phos-165* amylase-117* tot bili-20.8* dir bili-14.6* indir bil-6.2 05:12am lipase-133* 05:12am albumin-2.2* calcium-8.2* phosphate-3.5 magnesium-2.3 iron-41 05:12am caltibc-192* trf-148* 05:12am hbsag-negative hbs ab-negative hbc ab-negative 05:12am smooth-positive 05:12am -positive titer-1:1280 05:12am wbc-11.1* rbc-2.99* hgb-9.3* hct-28.0* mcv-94 mch-31.0 mchc-33.1 rdw-16.7* 05:12am neuts-76.6* lymphs-18.2 monos-4.5 eos-0.6 basos-0.2 05:12am plt count-168 05:12am pt-25.9* ptt-56.8* inr(pt)-2.6* 05:12am fdp-10-40 05:12am fibrinoge-80* . . studies from osh: u/s : gb contracted, no stones, bile ducts not dilated, liver texture inhomogenous and coarse - infiltrating cancer vs sclerotic changes, spleen borderline enlarged (12 cm) w/ satisfactory texture, kidneys/pancreas wnl, no ascites . ct abd/pelvis (): timy bilateral pl eff, mild bibasilar atelectasis, 8 cm left adnexal cyst and a heterogeneous lobulated uterus c/w fibroids, 2 small cysts in left kidney . cxr: no active dz . . studies from : cxr : 1. bilateral small to moderate pleural effusions. 2. left lower lobe atelectasis vs consolidation. 3. mild cardiac failure. . abd us : report: the liver is of heterogeneous echotexture throughout and also appears a little shrunken. within the posterior aspect of the liver is a 3.5-cm hyperechoic lesion that is producing some subtle deformity of the liver capsule. no other focal liver lesions are seen. the gallbladder cannot be visualized. there is no intra- or extra-hepatic biliary dilatation seen. the portal vein is patent with hepatopetal flow. the arteries of the left and right lobe and the main hepatic artery are seen and are patent. the hepatic veins also appear patent. both kidneys appear normal in size, shape and echotexture. there is no splenomegaly and the spleen measures 11 cm. . conclusion: the findings are consistent with cirrhosis. there is mild-to- moderate ascites. a single hyperechoic lesion is identified within the liver parenchyma which should be evaluated by multidetector ct and multiphasic ct. the differential diagnosis is wide including fat, hemangioma, adenoma, carcinoma. multidetector ct recommended. . tte : the left atrium is elongated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef 70-80%). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. there are focal calcifications in the aortic arch. the aortic valve appears bicuspid. the aortic valve leaflets are mildly thickened. there is no valvular aortic stenosis. the increased transaortic gradient is likely related to high cardiac output. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: bicuspid aortic valve without stenosis or regurgitation; hyperdynamic left ventricle . . kub : findings: the bowel gas pattern is unremarkable, with residual contrast in the ascending colon, without evidence of significant obstruction or dilatation. no evidence of free air is identified on this plain film. impression: no evidence of obstruction. . . renal us : normal renal ultrasound with no evidence of hydronephrosis. minimal amount of free fluid within the abdomen. . . cxr : findings: a nasogastric tube is in place with tip terminating in the upper gastric fundus just distal to the gastroesophageal junction. subsequent radiographs demonstrate advancement of the nasogastric tube. the heart size is normal. there is increased prominence of the azygos contour and new pulmonary edema with perihilar opacities and peripheral septal lines. small left pleural effusion. no pneumothorax. . . cxr : findings: endotracheal tube with tip 4.5 cm from carina. nasogastric tube in unchanged position. heart size and mediastinal contours are within normal limits. increasing diffuse bilateral airspace opacities and fluid within the minor fissure, as well as layering bilateral pleural effusions in this supine patient, suggest increasing pulmonary edema. there is no pneumothorax. osseous structures appear unchanged. impression: 1. lines and tubes in unchanged position. 2. mild increase in pulmonary edema and bilateral pleural effusions. . . trans jugular biopsy : liver, needle core biopsy: 1. severe portal/periportal and lobular mixed inflammation including neutrophils, plasma cells and eosinophils. 2. hepatocellular necrosis, single cell apoptosis and cholestasis with focal bile duct proliferation and areas of collapse (reticulin stain evaluated). 3. trichrome stain shows increase in portal fibrosis. 4. no increased iron seen on iron stain. . note: the findings are consistent with autoimmune hepatitis with severe activity and areas of collapse the degree of fibrosis is difficult to assess due to collapse. dr. . was notified of the preliminary results by dr. on . . . brief hospital course: 74yo f with recently diagnosed endometial cancer transferred from osh for continued w/u of new liver failure of unknown etiology. . 1. liver failure: the pt was originally diagnosed with liver disease at osh where she was found to be jaundiced. since her transfer here, she was found to have elevated lfts suggest underlying hepatitis. ddx was broad and included viral hepatitis, autoimmune hepatitis, infiltrative liver metastasis or primary, sclerosis, cholangiocarcinoma or hepatobiliary cancer related to ii, reaction to medication (concern re: otc cholesterol med), pbc, or psc. also on ddx includes hemochromatosis or wilson's dz. upon presentation here, the pt received an abdominal us which demonstrated findings consistent with cirrhosis as well as mild-to-moderate ascites and a single hyperechoic lesion is identified within the liver parenchyma which was concerning for adenoma vs. carcinoma. a wide panel of serologic markers were checked under the guidance of the liver team. hbv and hcv virus pcr was checked and found to be negative. in addition, hep b surface ab and ag as well as core ab was also neg. hcv igm were also negative. her hav ab was found to be positive, however this may have been indicative of a past exposure. other viral serologies were also negative for acute infection (cmv and ebv igm neg but igg positive indicating previous exposure but no acute infection). her iron studies were not consistent with hemochromotosis and her ceruloplasmin were wnl. however her serum immunoglobulin g levels were elevated at 3339 and her anti-smooth muscle antibody was positive 1:320 as was the 1:1280. in addition, her cea was normal at 3 (0-4) however ca -9 was elevated at 44(0-37), and afp was also elevated at 39.3 (0-8). a transjugular biopsy was performed on which demonstrated severe portal/periportal and lobular mixed inflammation including neutrophils, plasma cells and eosinophils. in addtion, she was also found to have hepatocellular necrosis, single cell apoptosis and cholestasis with focal bile duct proliferation and areas of collapse (reticulin stain evaluated). these findings were consistent with autoimmune hepatitis with severe activity. no increased iron seen on iron stain. therefore she was given a diagnosis of autoimmune hepatitis and started on iv solumedrol for treatment. in addition, given her worsening mental status, the pt was also started on lactulose and rifaximin as well. her liver functions continued to worsen and after several days her meld score was continuously in the 40s. her renal function also began to decline during her hospital course possibly due to hepatorenal syndrome vs. pre-renal azotemia vs. atn. she was given a trial of ivf bolus, however did not respond indicating more likely hrs vs. atn. at this point, she was transferred to the micu for further care. in the micu, the pt was continued on iv steroids for her autoimmune hepatitis, as well as her lactulose and rifaximin for her altered mental status. she was also started on octreotide and midodrine for presumed hrs. the pt was intubated for respiratory failure on . despite all aggressive measures including blood pressure support with levophed as well as mechanical ventilation, the pt continued to decline. as she was in oliguric renal failure, the pt was becoming progressively volume overloaded with clinically significant pulmonary edema. however given her poor prognosis, the pt was declined for liver transplant and shortly thereafter she was also declined for hemodialysis. due to difficulty ventilating/oxygenating the pt, discussions with the family re: goals of care were initiated. the pt was made dnr/dni (as she was already intubated, decision was to not re-intubate in the event the ett were to be dislodged or the pt was extubated) on . the following day, a family meeting was held with the daughter and son as well as the rn and the overnight ho in the icu. after significant discussion with the family, the pt was made cmo given her poor prognosis. this was corroborated with the over night micu attending. the fentanyl gtt was increased to provide maximal comfort for the pt. subsequently, a terminal extubation was performed on after which the pt deteriorated and expired. the family was informed, and a permission for limitted autopsy was attained (the family requested the face and brain of the pt not be touched during the autopsy). . 2. coagulopathy: on transfer to , the pt was found to have a significant coagulopathy with elevated inr. this was thought to be due primarily to her liver disease with possible nutritional component due to poor po. the pt was given a trial of vit k x 3 days and received ffp as well as cryoglobulin. however when the prognosis became apparent, further transfusions were held. . 3. elevated creatinine: the pt was admitted with a creatinine of 1.6. although we were unable to see trend in osh labs, the value continued to rise during this admission. this was initially thought to be due to prerenal azotemia given history of poor po intake. an ivf challenge was given without much success. urine lytes were consitent with a na avid state suggesting possible hepato-renal syndrome. renal u/s and ct from osh successfully ruled out hydronephrosis and possible post renal obstruction. the renal team was consulted re: the etiology and management of the renal failure. the pt progressively became more and more oliguric. given the concern for hrs, the pt was started on midodrine and octreotide without much improvement. as the renal team declined to initiate hd, the pt became progressively more volume overloaded with worsening pulmonary edema. . 4. id: the wbc count was elevated from 7 on at osh to 20s during her admission at . although this was obviously concerning for a possible infection, as she was also on high dose steroids, this may have been a steroid effect and not indicative of any acute infection. given the gravity of her illnes, however, the pt was started on levofloxocin for broad spectrum antibiotic coverage. levofloxcain was chosen for broad spectrum pulmonary source as she had some cough and an episode of hematemesis on with cxr findings of ?atelectasis. . 5. anemia: although the pt had a stable hct during this admission, iron studies (originally sent for evaluation of hemochromotosis) were consistent with fe def anemia. her stool guaiacs remained negative. this was therefore thought to be due to uterinr/endometrial bleeding from her endometrial ca. she was started on fe supplements. . 6. endometrial ca: this was not thought to be an active issue during this hospitalization while the pt was undergoing fulminant hepatic failure as above. . 7. ppx: the pt was placed on a bowel reg with lactulose. dvt prophylaxis was not initiated given her coagulopathy. . 8. contact: sister, , staying at best western. phone . . 9. code status: originally full code, then dnr/dni (do not re-intubate if extubated for any reason) and finally cmo. . medications on admission: otc "one a day cholesterol" discharge medications: none. the pt is deceased. discharge disposition: expired discharge diagnosis: deceased. discharge condition: deceased. discharge instructions: deceased. no instructions necessary. followup instructions: deceased. no instructions necessary. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube closed (percutaneous) [needle] biopsy of liver transfusion of packed cells transfusion of other serum transfusion of coagulation factors diagnoses: acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified long-term (current) use of steroids cirrhosis of liver without mention of alcohol acute and subacute necrosis of liver hepatorenal syndrome acquired coagulation factor deficiency acute respiratory failure cardiac arrest iron deficiency anemia, unspecified other chronic hepatitis malignant neoplasm of corpus uteri, except isthmus 

Answer: The patient is high likely exposed to