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 / gentamicin attending: chief complaint: atrial fibrillation major surgical or invasive procedure: cardiac catheterization colonoscopy history of present illness: 56m w/ multiple medical problems including cad s/p multiple pci, chf with ef 45%, paf, dm type i, esrd on hd s/p transplant x2 who presented to on after several episodes of atrial fibrillation and hypotension during hd and is now transferred to medicine for gi bleed. . he was originally admitted to on with complaints of r knee pain after a fall to his right side. he was seen by rheumatology and there was a concern for possible gout or pseudogout. during that admission, he underwent hd per his normal schedule and during hd on he went into a fib with a ventricular rate of 130-140. he had severe chest pain across his entire chest w/ radiation to his shoulders, jaw, and back. he also noted sob and a need to move his bowels during this episode. he was given iv amiodarone during this episode but remained in a fib for several hours before spontaneously converting to sinus rhythm. he was hypotensive to the 80's with elevated jvp and was given ivf and stress-dose steroids for possible adrenal insufficiency. an echocardiogram revealed ef 55% with possible inferior hk. his cardiac enzymes were checked and were normal. . on the day of transfer on , during hd he again had an episode of a fib associated with the same chest discomfort and hypotension. he received 200mg of amiodarone, 2.5mg iv lopressor x2, dilaudid, and ativan for this episode but remained in a fib up until the time of transfer to . he was also briefly hypotensive to the 80s and started on neosynephrine in the icu there. on transfer, the pt reported dull chest pain that was pleuritic. he denied other symptoms. . on admission to ccu, the patient stated that he had been on 200mg of amiodarone since last when his colostomy was reversed. he had mild chest pain during hd for the past few weeks but the episodes during his previous hospitalization had been much more severe. there were no recent changes in his dialysis treatment. he had a mild non-productive cough over the week prior to admission but denied fever, diarrhea, constipation, nausea, decreased po intake, or ha. he has had chronic abdominal pain for the past year. his knee pain began about 2 weeks ago and had responded well to nsaids. he stopped his nsaids because he was told that they can cause gi bleeds if taken for too long. past medical history: 1. esrd: status pancreas-kidney transplant , status post cadaveric transplantation in , now requiring dialysis 3x/wk 2. cad: s/p myocardial infarction in , s/p lcx stenting in , s/p lcx and om3 stenting in , s/p mid-lcx stenting on ', s/p om3 restenting in ' 3. dm 4. hypothyroidism 5. hypercholesterolemia 6. hep c (dx in '), viral load 7. cva in with residual left-sided weakness 8. pvd 9. diverticulitis, status post colostomy and hartmann's pouch in , status post reversal in , last colonscopy (): erythema, friability and granularity in the very distal portion of the colon, just inside the afferent limb of the stoma, with overlying clot. brown stool with no bleeding proximal to this. 10. pvd s/p multiple digit amputations 11. gerd 12. wheelchair bound after gentamicin related vertigo 13. paf: diagnosed in , continued on ccb and started on amio at that time 14. benign prostatic hypertrophy, status post transurethral resection of the prostate. 15. sbp social history: patient lives with his wife. they have two children who live nearby. he previously worked as a plummer but is now retired. he has a 30pk year smoking hx but quit 10 years ago. he denies ivdu and alcohol use. family history: father died at age 56 of mi, with dm and a "big heart". mother died age 84 of "old age" s/p cva, with dm and htn. sister has grave's dz and brother died of 56 with dm. physical exam: vitals: t 97.5 bp 106/39 (92-135/27-65) hr 58 (58-73) 18 98% ra gen: well-appearing man, laying flat in bed, nad heent: perrl, eomi, mmm, op clear neck: supple, no jvd or lad lung: crackles at left base, otherwise cta bilaterally cor: rrr, nml s1s2, 2/6 systolic ejection murmur heard best at the lsb w/out radiation abd: large midline scar, well-healed, hyperactive bowel sounds, mildly distended with mild ttp in bilateral flanks, + splenomegaly ext: changes of chronic venous insufficiency, no edema, could feel distal pulses, right knee without effusion, mild medial joint line tenderness, no pain on passive movement, pain on active movement pertinent results: imaging: cath (): the left anterior descending coronary artery has mild diffuse disease in the proximal, mid, and distal portions. the ramus is a branching vessel that has a 70-80% stenosis at the upper pole. the left circumflex artery is the dominant vessel and is patent in the proximal portion. there is 60% in-stent restenosis in the mid-circumflex artery and the distal circumflex has diffuse disease. om1 and om2 are small vessels. om3 has a 100% occlusion that is likely chronic. the right coronary artery is non-dominant and has a 70% proximal occlusion, the mid and distal vessel is without significant flow limiting disease. left heart catheterization revealed normal diastolic filling pressures. . echo (): mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. elevated lvedp. pulmonary artery systolic hypertension. mild mitral regurgitation. . femoral vascular us (): no evidence of arteriovenous fistula or pseudoaneurysm. . kub (): limited study. mild ascites.no acute pathology is demonstrated. . abd ct (): liver heterogenous attenuation throughout with two discrete foci of increased attenuation. one anteriorly in segment 8, the other more posteriorly in segment 6 and laterally. splenomegaly and the spleen measures nearly 16 cm in craniocaudad direction. in addition, peripherally there is a wedge-shaped area of hypoattenuation. this likely reflects the vascular phase of enhancement, but would also be consistent with a splenic infarct. both native kidneys are markedly shrunken and atrophic. there is evidence of marked osteopenia. in addition, multilevel fractures are identified, including the pelvic bones, left iliac bone and left femur. brief hospital course: 1. atrial fibrillation: the patient was transferred to the ccu from the osh with a recent history of atrial fibrillation and hypotension complicating his hemodialysis treatments. this was considered potentially related to his coronary artery disease and ischemia. on hospital day 2, he underwent cardiac catheterization, which revealed disease in lcx and om3. the plan was for medical management, without intervention. the pt was then evaluated by ep for possible ablation. ep recommended increasing amiodarone and not doing ablation at this time. his amiodarone and beta blocker doses were titrated and he remained in normal sinus rhythm throughout the remainder of his hospitalization, with the exception of one episode of atrial fibrillation during dialysis. . 2. cad: as noted previously, the patient underwent cardiac catheterization on transfer from the osh. the left main was calcified and widely patent. the left anterior descending coronary artery had mild diffuse disease in the proximal, mid, and distal portions. the ramus had 70-80% stenosis at the upper pole and the left circumflex artery was patent in the proximal portion with a 60% in-stent restenosis in the mid-circumflex and diffuse disease in the distal circumflex. om3 had a 100% occlusion that is likely chronic. the right coronary artery is non-dominant and had a 70% proximal occlusion. the decision was made for medical management and the patient was continued on aspirin, statin and beta blocker with nitro prn for chest pain. he remained chest pain free throughout his admission. . 3. gib: during his ccu stay, he had several episodes of maroon-colored stools with brbpr, which were guaiac positive. his hct was stable and he remained hemodynamically stable. his heparin and coumadin were discontinued and gi was consulted. given his multiple comorbidities and need for long-term anticoagulation as an outpatient, it was decided to perform a colonscopy while the patient was in-house and his anticoagulation held. the patient was transferred to the medicine service for this procedure. colonoscopy was performed on and revealed esophageal varices and portal hypertensive gastropathy. for this reason, coumadin will not be restarted as an outpatient. . 4. abdominal pain: during his stay in the ccu, the patient also developed severe diffuse abdominal pain and distension on . a kub showed a possible small bowel obstruction. the patient was evaluated with an abdominal ct which showed possible hypoattenuation in the liver and a possible splenic infarct, without evidence of obstruction, though it was an inadequate study because the pt refused to finish the contrast. the patient's abdominal pain subsequently improved. an mri was performed to further evaluate the areas of hypoattenuation and revealed peripheral wedge shaped areas of arterial hyperenhancement within the liver consistent with perfusion abnormalities without a focal hepatic mass identified. continued follow up is recommended because of the patient's known history of liver disease. it also revealed a cirrhotic liver with evidence of portal hypertension and splenomegaly, with an area of t1 hypointensity in the spleen which most likely represents an area of splenic hypoperfusion in combination with focal iron deposition . 5. esrd: the patient was followed by throughout his stay and had scheduled hemodialysis. . 6. knee pain: during his hospitalization at the osh and here, the patient has had persistent right knee pain which improved with nsaids and steroids at the osh. his physical exam was significant for pain on active movement and not passive movement, with medial joint tenderness. this suggests a possible mcl injury vs. tendonitis vs. anserine bursitis. rice was recommended and the patient received percocet for pain. nsaids were held in the setting of his gi bleed. . 7. hypothyroidism: his tsh was within normal limits on admission and his synthroid was continued. . 8. hepatitis c: patient has a known history of hepatitis c. colonoscopy revealed portal hypertensive gastropathy and varices. coumadin will not be continued due to varices. his toprol xl was continued rather than switching to nadolol. he will be seen by a gastroenteritis as an outpatient. medications on admission: meds: (at osh) 1. amitriptyline 10mg qhs 2. liptitor 10mg qd 3. phosphorus 167mg tid 4. lantus 14u qhs 5. imdur 30mg qd 6. synthroid 0.2mg qd 7. protonix 40mg qd 8. prednisone 30mg qd 9. renagel 800mg tid 10. bactrim ds 1tab q mon/wed/fri 11. amiodarone 200mg qd 12. asa 160mg qd 13. toprol 25mg qd discharge medications: 1. amitriptyline 10 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 2. atorvastatin calcium 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. levothyroxine sodium 200 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po mon/wed/fri (). disp:*12 tablet(s)* refills:*2* 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. metoprolol succinate 25 mg tablet sustained release 24hr sig: 0.5 tablet sustained release 24hr po daily (daily). disp:*15 tablet sustained release 24hr(s)* refills:*2* 8. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 9. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 10. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day). disp:*2700 ml(s)* refills:*2* 11. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. disp:*20 tablet, sublingual(s)* refills:*0* 12. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed: do not exceed more than six tablets in one day. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service discharge diagnosis: primary diagnoses: 1. atrial fibrillation 2. coronary artery disease 3. gi bleed, likely secondary to esophageal varices secondary diagnoses: 1. end-stage disease on hemodialysis 2. knee pain 3. diabetes mellitus 4. portal hypertensive gastropathy 5. esophageal ulcer 6. peripheral vascular disease 7. hypothyroidism 8. hypercholesterolemia discharge condition: good, stable hematocrit discharge instructions: you are discharged to home and should continue all medications as prescribed. please contact your physician or present to the er if you experience chest pain, palpitations, lightheadedness, fevers, chills, maroon-colored stools, blood from your rectum or other concerns. please keep all follow-up appointments. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1500cc followup instructions: you have a follow-up appointment with your primary care physician . on at 3:20pm. you should call his office to see if you can schedule something sooner. office number provider: , md where: lm center phone: date/time: 10:30 please call gastroenterologist dr. to schedule an outpatient appointment in one month after discharge. procedure: coronary arteriography using two catheters other endoscopy of small intestine left heart cardiac catheterization hemodialysis colonoscopy transfusion of other serum diagnoses: congestive heart failure, unspecified cirrhosis of liver without mention of alcohol portal hypertension unspecified acquired hypothyroidism unspecified viral hepatitis c without hepatic coma atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease pain in joint, lower leg blood in stool complications of transplanted kidney diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled hypotension of hemodialysis colostomy status complications of transplanted pancreas esophageal varices without mention of bleeding 

Answer: The patient is high likely exposed to