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: no known allergies / adverse drug reactions attending: chief complaint: r hip pain major surgical or invasive procedure: : s/p left total hip revision history of present illness: 62 year old man with cirrhosis c/b grade 1 esophageal varices and past gib's, crohn's s/p ileostomy, copd, htn, pancytopenia, gerd, depression, avascular necrosis chronic prednisone use s/p l hip replacement with massive osteolysis of pelvis/acetabulum and proximal femur, extended femoral osteotomy (clamshell) with multiple open reduction and internal fixations who is admitted to the icu for monitoring after 3rd attempt of total hip replacement. . the patient was previously discharged on s/p total resection arthroplasty on . post-operatively, the patient was noted to be confused coming out of the or and overnight. he was initially transferred to icu post surgery because of hypotension and was on pressors with subsequent normalization of blood pressures. post-op course was also complicated by hepatic/toxic-metabolic encephalopathy, cleared with rifaximin and lactulose, and by acute kidney injury. past medical history: past medical history: - htn - dyslipidemia - ascending aortic aneurysm, not involving the coronary vessels - bicuspid aortic valve - etoh cirrhosis c/b esophageal varices and bleeding: baseline liver enzymes alt 21, ast 30, alk 190, tbili 1.2 - pancytopenia: baseline wbc 1.7, hgb 12.3, hct 35.8, plt 54 - thrombocytopenia - crohn's disease s/p ileostomy - prostate cancer - kyphosis - copd - gerd - squamous cell carcinoma s/p resection - avascular necrosis of left hip secondary to prednisone - depression - baseline bun 15, cr 1.0 . past surgical history: - squamous cell carcinoma excisions x 3 forehead () - l distal radius orif () - partial colectomy with transverse colostomy and mucous fistula - mucous fistula takedown - left wrist surgery - left hip replacement (20 years ago) - avascular necrosis of left hip secondary to crohn's/prednisone, - complex complete resection arthroplasty of failed left total hip replacement; extended femoral osteotomy (clamshell) with multiple open reduction and internal fixation cerclage wires social history: he is retired from the department of social services, former widower, has a girlfriend. - tobacco: previous use - alcohol: prior history of alcohol abuse, no longer drinking in 22 months per pt, family and pcp. : denies family history: positive for hemophilia but not affecting this patient, although he does have thrombocytopenia. physical exam: well appearing in no acute distress afebrile with stable vital signs pain well-controlled respiratory: ctab cardiovascular: rrr gastrointestinal: nt/nd, ostomy rlq, hernia llq genitourinary: voiding independently neurologic: intact with no focal deficits psychiatric: pleasant, a&o x3 musculoskeletal lower extremity: * incision healing well with staples * scant serosanguinous drainage * thigh full but soft * no calf tenderness * 5/5 strength * silt, nvi distally * toes warm pertinent results: 11:30am blood hgb-12.5* hct-34.4* plt ct-53* 06:00pm blood hgb-9.7* hct-27.6* plt ct-85*# 08:43pm blood wbc-1.9* rbc-3.36* hgb-11.5* hct-33.2* mcv-99* mch-34.2* mchc-34.6 rdw-18.3* plt ct-62* 03:39am blood wbc-3.4*# rbc-3.01* hgb-10.6* hct-29.3* mcv-97 mch-35.2* mchc-36.2* rdw-19.2* plt ct-84* 04:07pm blood wbc-3.7* rbc-2.66* hgb-9.2* hct-25.5* mcv-96 mch-34.8* mchc-36.2* rdw-18.9* plt ct-83* 06:20am blood wbc-1.5*# rbc-2.15* hgb-7.5* hct-21.1* mcv-98 mch-35.0* mchc-35.6* rdw-19.3* plt ct-51* 12:30am blood wbc-1.8* rbc-2.68* hgb-9.0* hct-25.4* mcv-95 mch-33.7* mchc-35.5* rdw-18.6* plt ct-43* 06:25am blood wbc-1.2* rbc-2.71* hgb-9.2* hct-26.1* mcv-97 mch-33.9* mchc-35.1* rdw-18.6* plt ct-42* 07:20am blood wbc-1.3* rbc-2.79* hgb-9.6* hct-26.8* mcv-96 mch-34.3* mchc-35.7* rdw-18.3* plt ct-43* 07:20am blood wbc-1.3* rbc-2.79* hgb-9.6* hct-26.8* mcv-96 mch-34.3* mchc-35.7* rdw-18.3* plt ct-43* 06:05am blood wbc-1.3* rbc-2.79* hgb-9.7* hct-27.5* mcv-99* mch-34.9* mchc-35.4* rdw-18.8* plt ct-42* 08:43pm blood neuts-88.5* bands-0 lymphs-3.9* monos-7.0 eos-0.5 baso-0.1 03:39am blood neuts-89.0* bands-0 lymphs-4.2* monos-6.2 eos-0.1 baso-0.5 07:20am blood neuts-80.2* lymphs-9.1* monos-7.6 eos-2.5 baso-0.5 08:43pm blood glucose-140* urean-14 creat-0.7 na-138 k-4.6 cl-113* hco3-19* angap-11 03:39am blood glucose-119* urean-16 creat-0.8 na-138 k-4.4 cl-112* hco3-19* angap-11 06:20am blood glucose-135* urean-17 creat-0.9 na-140 k-3.6 cl-109* hco3-24 angap-11 06:25am blood glucose-94 urean-13 creat-0.7 na-141 k-3.3 cl-109* hco3-25 angap-10 07:20am blood glucose-98 urean-11 creat-0.7 na-142 k-3.4 cl-108 hco3-24 angap-13 06:05am blood glucose-134* urean-12 creat-0.9 na-140 k-3.6 cl-108 hco3-24 angap-12 brief hospital course: the patient was admitted to the orthopaedic surgery service and was taken to the operating room for above described procedure. please see separately dictated operative report for details. the surgery was uncomplicated and the patient tolerated the procedure well. patient received perioperative iv antibiotics. postoperative course was remarkable for the following: 1. icu course: # s/p left hip replacement: patient tolerated the procedure well per ortho although he did have significant blood loss and fluid shifts. he had a rij placed in the or the postition of which was confirmed on presentation to the . post-op hct stable at 33.2. he received ancef for 24 hours after the procedure. was intubated on admission to unit. he was cautiously weaned from the vent and from propofol given his prior history of difficulty with extubation and altered mental status. opiods were avoided in management of the patient's pain. he was given small fentanyl boluses for pain through the night. he was extubated in the morning without difficulty. the jp drains contained serosanginous fluid, and on pod1 the patient was started on enoxaparin 40mg sc daily. pain management was an issue given the patient's underlying hepatic dysfunction. the acute pain and the chronic pain services were consulted regarding a lumbosacral block. it was decided that in place of a lumbosacral block, the patient's dilaudid pca would be increased to dose to .24/6m and his long-acting oxycontin po 10 mg q6h. the patient was successfully extubated upon leaving the . . # etoh cirrhosis - blood transfusions and insult of surgery would contribute to higher likelihood of post-op hepatic encephalopathy. patient does have history of grade 1 varices as well. mental status was monitored through course and the patient did not have hepatic encephalopathy on exam. lactulose was started after the patient was extubated. his home nadolol was initially held low bp, but this was restarted after extubation. . # pancytopenia - history of thrombocytopenia cirrhosis as well as pancytopenia, (which on previous workup by heme/onc was felt to medication, portal sequestration). macrocytic anemia consistent with history of alcohol and cirrhosis. cbc was monitored with a goal of keeping platelets > 10 or 50 if acute bleeding. through his course in the , the patient had an active type and screen. no transfusions were required post-operatively in the . . # crohn's disease - stable, not having diarrhea. continued with azathioprine when taking pos. . # htn - initially held lisinopril for now pending fluid shifts and post op hypotension. . # copd - documented h/o copd in omr but on no home medications. # ascending aortic aneurysm: stable on recent echo. vs were monitored. . # depression: home duloxitine was continued. 2. asymptomatic post-operative anemia - pod 2 hct 21.1 -> transfused 2 units prbcs 3. medicine consult for co-management otherwise, pain was initially controlled with a pca followed by a transition to oral pain medications on pod#2. the patient received lovenox for dvt prophylaxis starting on the morning of pod#1. the foley was removed on pod#2 and the patient was voiding independently thereafter. the surgical dressing was changed on pod#2 and the surgical incision was found to be clean and intact without erythema or abnormal drainage. the patient was seen daily by physical therapy. labs were checked throughout the hospital course and repleted accordingly. at the time of discharge the patient was tolerating a regular diet and feeling well. the patient was afebrile with stable vital signs. the patient's hematocrit was acceptable and pain was adequately controlled on an oral regimen. the operative extremity was neurovascularly intact and the wound was benign. the patient's weight-bearing status is touchdown weight bearing on the operative extremity with posterior and trochanter off precautions. mr. is discharged to rehab in stable condition. medications on admission: medications at home: azathioprine - (prescribed by other provider) - 50 mg tablet - 2-1/2 tablet(s) by mouth once daily duloxetine - (prescribed by other provider) - 60 mg capsule, delayed release(e.c.) - one capsule(s) by mouth daily folic acid - (prescribed by other provider) - 1 mg tablet - 1 tablet(s) by mouth once daily lisinopril - (prescribed by other provider) - 10 mg tablet - one tablet(s) by mouth daily nadolol - (prescribed by other provider) - 40 mg tablet - one tablet(s) by mouth daily oxycodone - (prescribed by other provider) - 20 mg tablet extended release 12 hr - 1 tablet(s) by mouth twice daily oxycodone-acetaminophen - (prescribed by other provider) - 5 mg-325 mg tablet - 1 tablet(s) by mouth every 4-6 hours as needed for pain sodium chloride - (prescribed by other provider) - - 4 mg daily trazodone - (prescribed by other provider) - 50 mg tablet - 1 tablet(s) by mouth once a day . medications - otc calcium - (prescribed by other provider) - dosage uncertain cyanocobalamin (vitamin b-12) - (prescribed by other provider) - dosage uncertain magnesium oxide - (prescribed by other provider) - 400 mg tablet - 6 tablet(s) by mouth three times a day multivitamin - (prescribed by other provider) - dosage uncertain omeprazole magnesium - (prescribed by other provider) - 20 mg tablet, delayed release (e.c.) - two tablet(s) by mouth daily . medications on transfer to icu: -lisinopril 10 mg po/ng daily -acetaminophen 650 mg po q6h -milk of magnesia 30 ml po bid:prn constipation -bisacodyl 10 mg po/pr daily:prn constipation -multivitamins 1 cap po daily -cefazolin 2 g iv q8h (2 hrs post-op) -nadolol 40 mg po daily -calcium carbonate 500 mg po tid -oxycodone (immediate release) 5-10 mg po q4h:prn pain start: in am begin after pca has been d/c -docusate sodium 100 mg po bid -ondansetron 4 mg iv q8h:prn nausea/vomiting -duloxetine 60 mg po daily -omeprazole 20 mg po daily -enoxaparin sodium 40 mg sc daily start: in am begin on wednesday -senna 1 tab po bid -folic acid 1 mg po/ng daily -vitamin d 400 unit po daily order date: @ 1103 -hydromorphone (dilaudid) 0.12 mg ivpca lockout interval: 6 minutes basal rate: 0 mg(s)/hour 1-hr max limit: 1.2 mg(s) discharge medications: 1. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 2. multivitamin tablet sig: one (1) cap po daily (daily). 3. duloxetine 30 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 4. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 7. nadolol 20 mg tablet sig: two (2) tablet po daily (daily). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. acetaminophen 325 mg tablet sig: two (2) tablet po q8h (every 8 hours). 10. azathioprine 50 mg tablet sig: 2.5 tablets po daily (daily). 11. enoxaparin 40 mg/0.4 ml syringe sig: one (1) syringe subcutaneous daily (daily) for 3 weeks. disp:*21 syringe* refills:*0* 12. aspirin, buffered 325 mg tablet sig: one (1) tablet po twice a day for 3 weeks: after completing lovenox, take as directed with food. disp:*42 tablet(s)* refills:*0* 13. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day): take while on strong pain medication. disp:*2700 ml(s)* refills:*2* 14. oxycodone 5 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain: hold for confusion. disp:*50 tablet(s)* refills:*0* 15. outpatient lab work daily cbc with diff at rehab until his wbc counts increase. if he were to become neutropenic or show signs of infection, would recommend stopping azathioprine. would transfuse prn for goal plt >10 and hct > 21. discharge disposition: extended care facility: rehabilitation and nursing center - discharge diagnosis: failed left total hip replacement post-operative anemia due to blood loss chronic pancytopenia *anticipated length of stay < 30 days* discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: 1. please return to the emergency department or notify your physician if you experience any of the following: severe pain not relieved by medication, increased swelling, decreased sensation, difficulty with movement, fevers greater than 101.5, shaking chills, increasing redness or drainage from the incision site, chest pain, shortness of breath or any other concerns. 2. please follow up with your primary physician regarding this admission and any new medications and refills. 3. resume your home medications unless otherwise instructed. 4. you have been given medications for pain control. please do not drive, operate heavy machinery, or drink alcohol while taking these medications. as your pain decreases, take fewer tablets and increase the time between doses. this medication can cause constipation, so you should drink plenty of water daily to prevent this side effect. call your surgeons office 3 days before you are out of medication so that it can be refilled. these medications cannot be called into your pharmacy and must be picked up in the clinic or mailed to your house. please allow an extra 2 days if you would like your medication mailed to your home. 5. you may not drive a car until cleared to do so by your surgeon. 6. please keep your wounds clean. you may shower starting five (5) days after surgery, but no tub baths or swimming for at least four (4) weeks. no dressing is needed if wound continues to be non-draining. any stitches or staples that need to be removed will be taken out by the visiting nurse (vna) or rehab facility two weeks after your surgery. 7. please call your surgeon's office to schedule or confirm your follow-up appointment in four (4) weeks. 8. please do not take any non-steroidal anti-inflammatory medications (nsaids such as celebrex, ibuprofen, advil, aleve, motrin, etc). 9. anticoagulation: please continue your lovenox for three (3) weeks to help prevent deep vein thrombosis (blood clots). after completing the lovenox, please take aspirin 325mg twice daily for three weeks. stockings x 6 weeks. 10. wound care: please keep your incision clean and dry. it is okay to shower five days after surgery but no tub baths, swimming, or submerging your incision until after your four (4) week checkup. please place a dry sterile dressing on the wound each day if there is drainage, otherwise leave it open to air. check wound regularly for signs of infection such as redness or thick yellow drainage. staples will be removed by the visiting nurse or rehab facility in two (2) weeks. 11. vna (once at home): home pt/ot, dressing changes as instructed, wound checks, and staple removal at two weeks after surgery. 12. activity: touchdown weight bearing on the operative extremity. posterior and trochanter off precautions. no strenuous exercise or heavy lifting until follow up appointment. physical therapy: lle touchdown weight bearing posterior and trochanter off precautions mobilize treatments frequency: dry sterile dressing daily as needed for drainage wound checks ice as tolerated staple removal pod 17 - replace with steristrips teds followup instructions: provider: , : date/time: 11:00 procedure: revision of hip replacement, both acetabular and femoral components diagnoses: thrombocytopenia, unspecified esophageal reflux unspecified essential hypertension long-term (current) use of steroids acute posthemorrhagic anemia alcoholic cirrhosis of liver thoracic aneurysm without mention of rupture chronic airway obstruction, not elsewhere classified personal history of malignant neoplasm of prostate depressive disorder, not elsewhere classified other and unspecified hyperlipidemia regional enteritis of unspecified site personal history of other malignant neoplasm of skin surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation congenital insufficiency of aortic valve ileostomy status hip joint replacement esophageal varices without mention of bleeding alcohol abuse, in remission family history of other blood disorders peri-prosthetic osteolysis 

Answer: The patient is high likely exposed to