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: past medical history: 1. type 2 diabetes diagnosed four years ago when he started steroids. he was originally on metformin but recently began insulin in for worsening sugars. last hemoglobin a1c (per patient) was 11.4. 2. polymyalgia rheumatica diagnosed four years ago. symptoms are much improved after starting on steroids. 3. temporal arteritis. 4. benign prostatic hypertrophy, status post transurethral resection of prostate; diagnosed approximately 11 to 15 years ago. the patient has urinary hesitancy but denies any urinary retention. biopsy showed no evidence of prostate cancer (per patient). last prostate-specific antigen (per primary care physician) was 2.6. 5. hypertension. 6. hypercholesterolemia. 7. chronic lower extremity edema with a question of congestive heart failure. medications on admission: 1. methylprednisolone 4 mg p.o. q.a.m. and 2 mg p.o. q.h.s. 2. spironolactone 50 mg p.o. q.d. 3. metformin 1500 mg p.o. at dinner. 4. pravastatin 10 mg p.o. q.h.s. 5. lisinopril 20 mg p.o. q.a.m. 6. furosemide 80 mg p.o. q.a.m. 7. tylenol p.o. p.r.n. 8. humalog 75/25 22 units q.a.m. and 12 units q.p.m. allergies: the patient has no known drug allergies. family history: the patient has a twin brother who had type 1 diabetes. the patient's mother and another brother had type 2 diabetes. social history: the patient is a former smoker and quit approximately 50 years ago. he drinks approximately one glass of wine per day. he denies any illicit drug use. the patient lives with his wife in , . the patient was in the army during world war ii; then worked as a truck driver, and then was a contractor. he has since retired. he has two children; one daughter who lives in the area, and one son who lives in . physical examination on presentation: temperature of 98.1, pressure of 140/70, pulse of 95, respiratory rate of 18, satting 98% on room air. in general, the patient was a thin, elderly, white male lying in bed in no acute distress. he had a hoarse voice. head, eyes, ears, nose, and throat showed pupils were equal and reactive to light. extraocular movements were intact. his sclerae were anicteric. the oropharynx was moist. there were no petechiae noted. the neck was supple. there was no cervical lymphadenopathy. there was no thyromegaly. there was no elevated jugular venous pressure. the heart had a regular rate and rhythm with a 2/6 systolic murmur heard most prominently at the left upper sternal border. the lungs had faint crackles in the left lower lobe and were otherwise clear. the back had no costovertebral angle tenderness. there was slight pitting edema over the middle back. there was no point tenderness. the abdomen was soft, nontender, and nondistended. there was no rebound or guarding. no hepatosplenomegaly. the bowel sounds were normal. the extremities showed 2+ femoral pulses bilaterally, 1+ dorsalis pedis pulses bilaterally. there was no lower extremity edema. the left foot showed a dry crusted ulcer over the medial aspect of the first metatarsal head and the lateral posterior heel. the right foot showed a dry crusted ulcer over the medial aspect of the first metatarsal head and the medial posterior heel. the skin showed decreased turgor. neurologic examination showed cranial nerves ii through xii to be grossly intact. proprioception was slightly impaired in the left extremities bilaterally. pertinent laboratory data on presentation: laboratories on admission showed a white cell count of 11.7, hematocrit of 30.3, platelets of 269, mean cell volume of 87. sodium of 139, potassium of 6.1 (status post insulin and kayexalate), chloride of 102, bicarbonate of 18, urea nitrogen of 100, creatinine of 2.3, sugar of 189. hospital course: the patient was admitted to the general medicine service for further evaluation and management of his new onset renal failure. in addition, there was concern over his recent fatigue, shortness of breath, cough, and new hoarse voice. 1. renal: the patient was felt to be most likely prerenal given his physical examination findings as well as a bland urine sediment, negative urinalysis, and fena of less than 1%. he had a renal ultrasound which was normal. he was hydrated for the first two hospital days, and his creatinine had come down to 1.3 by the morning of . he had a magnetic resonance angiography of the renal arteries done on which showed mild right-sided renal artery stenosis. his zestril and diuretics were held initially. spep and upep were negative. a coude catheter was placed on the second hospital day in order to closely monitor the patient's ins-and-outs. a regular foley catheter was unable to be placed after three attempts by the nurses. the patient then developed fevers on and was found to have a urinary tract infection. the coude catheter was therefore removed on , and the patient was started on renally dosed levaquin. during this same time period (on ) when the patient developed rigors, he also appeared clinically fluid overloaded on examination with bibasilar crackles which were increased from the time of admission. he had received 2 units of packed red cells the night prior, and it was felt that he may have become fluid overloaded in this setting. his urea nitrogen and creatinine had come down to 46 and 1.3 at that time. the patient received two doses of lasix on that day; each time 40 mg p.o. his intravenous fluids were also discontinued on . his creatinine was then stable on , and he was feeling better. on , his creatinine had slightly bumped to 1.5. he was still on lasix 40 mg p.o. q.d. he had not restarted his aldactone which he was on as an outpatient. zestril 5 mg was added on to see if any element of pump dysfunction was causing the patient's increasing creatinine. however, the patient's creatinine stayed at 1.5 the next day while on the zestril and lasix. the zestril was then discontinued, and the lasix 40 mg p.o. q.d. was continued. on , the patient's creatinine again bumped to 1.8, so his lasix was discontinued as well, and he was gently rehydrated. at the time of this discharge summary he was currently being gently rehydrated, and a repeat creatinine will be checked tomorrow. in addition, a new fena will be calculated, and the urine will again be spun to look at the sediment. 2. cardiovascular: the patient had a question of a history of congestive heart failure given his lower extremity edema. he was on significant diuretic doses as an outpatient but did present with clinical dehydration; so, it was unclear as to whether he actually required diuretics or not. his primary care physician was and an echocardiogram had never been performed on the patient. therefore, an echocardiogram was obtained here both to evaluate him with regard to his fluid management as well as for possible preoperative evaluation if he is going to undergo bypass surgery. the findings of the echocardiogram showed the left atrium to be mildly dilated. there was mild symmetric left ventricular hypertrophy. the left ventricular cavity size was normal. the regional left ventricular wall motion was normal. the left ventricular ejection fraction was normal at greater than 55%. the aortic loop was mildly dilated. the aortic valve leaflets were moderately thickened, and there was trace aortic regurgitation. there was mild-to-moderate mitral regurgitation. although the patient carried a diagnosis of hypertension, he had no episodes of hypertension while admitted. the highest pressure recorded was 140/70 on admission. in fact, on , the patient developed hypotension into the 80s in the setting of low sugars as well as hypothermia. he was rigoring. it was felt he was hypoglycemic initially secondary to his evening insulin dose. however, later in the day on , he continued to rigor and also developed a relative fever of 99.5 which was up from 95 earlier in the morning. he was cultured and found to have the urinary tract infection as already described. he was given stress-dose steroids for one day given concern for possible adrenal insufficiency in the setting of his chronic steroid use and new infection. his pressure has been stable and has been in the 100 to 120 range. 3. infectious disease: the patient developed a urinary tract infection in the setting of catheter placement as already described. he is currently on day of levaquin renally dosed. in addition, there were 1/2 cultures which came back with staphylococcus aureus. these cultures were drawn on , prior to the patient's episodes of hypotension and rigors. it was unclear who ordered these cultures or if they were even the patient's actual cultures. there was possible concern for osteomyelitis given that these cultures grew staphylococcus aureus, so plain films were obtained of both feet which showed no evidence of osteomyelitis. a magnetic resonance imaging could be considered to fully evaluate for the possibility of osteomyelitis in the feet; however, given that his ulcers have been there for approximately four months, and the plain films showed no evidence, it was unlikely that the patient does have osteomyelitis. at the time of this discharge summary, the decision has been to hold off on any further imaging of the feet. it should be noted that the urine culture came back positive for enterobacter cloacae which was sensitive to levaquin. 4. pulmonary: there was concern for possible pulmonary malignancy given the patient's history of fatigue, sputum, chronic cough, and new hoarseness. a chest x-ray was initially obtained which showed fullness in the aorticopulmonary window. the lung showed emphysema and scattered linear areas of scarring. there was no obvious masses on chest x-ray. on , the patient began coughing up flecks of , a ct scan was obtained of the chest to more fully evaluate the possible full aorticopulmonary window. the chest ct showed no evidence of an aorticopulmonary window mass. there were several small subcentimeter mediastinal lymph nodes present in the aorticopulmonary window as well as throughout the mediastinum. these nodes were nonspecific, but could be related to a chronic infiltrative lung disease. there was a subpleural pattern of ground glass and reticular opacities with some associated traction bronchiectasis and bronchiolitis which involved all lobes but was most prominent in the lung bases. these findings were felt to be consistent with possible usual interstitial pneumonia, nonspecific interstitial pneumonia, infectious etiology such as mycobacterium avium-intracellulare. at the time of this discharge summary, a sputum culture has been obtained which was showing 1+ gram-positive cocci in pairs and clusters and 1+ gram-negative rods. the culture was still pending. in addition, a culture will be obtained for acid-fast bacillus looking for possible atypical mycobacteria. a repeat chest was recommended in approximately three months to document any possible progression of the lymphadenopathy as well as the reticular infiltrates. 5. endocrine: the patient has a history of diabetes and has been restarted on his humalog 75/25. this was held during his episodes of hypoglycemia on . since then we have been titrating his dose and have most recently increased his morning dose to 22 units, and his bedtime dose is currently at 8 units. the patient continues to have good morning and midway sugars with elevated sugars in the 300s after dinner and in the evening. some regular insulin given at dinner time may help these chronically elevated evening sugars. at this time, this has not yet been instituted. the patient also may have had some adrenal insufficiency in the setting of his urinary tract infection as already described. he was on hydrocortisone for one day and has since been on only his former medrol doses. 6. hematology: the patient's hematocrit was 30.3 at the time of admission, but on the third hospital day it dropped down to 23.3 in the setting of his hydration. there was no obvious acute loss. the patient has a history of gastrointestinal bleeding, and stools were attempted to be guaiaced. the patient received 2 units on , and his hematocrit appropriately bumped to 32.5. it has remained stable around 30 since that time. he most recently had a rectal examination by vascular surgery on the day of this discharge summary, and the vascular surgeon reported the stool to be guaiac-positive. we are currently watching the hematocrit q.d. and will transfuse for less than 27. if the hematocrit again was to drop, the patient will need an inpatient gastrointestinal workup for possible gastrointestinal sources of bleeding. until then, he was being continued on his iron supplementation. regardless, he will need a gastrointestinal workup prior to any vascular surgery to evaluate his guaiac-positive stool. 7. gastrointestinal: the patient has a history of gastrointestinal bleeding and has guaiac-positive stools as described above. he will get either an inpatient or outpatient esophagogastroduodenoscopy and colonoscopy to evaluate his guaiac-positive stool pending stability of his hematocrit. if his creatinine remains stable, he can have the workup as an outpatient. 8. fluids/electrolytes/nutrition: the patient's potassium was elevated on admission but was brought down nicely with the insulin, d-50, calcium gluconate, and kayexalate. he has since had no problems with hyperkalemia. 9. vascular: the patient had noninvasive arterial studies on . this examination showed significant bilateral tibial disease, greatest on the right side compared to the left. the ankle-brachial index on the right based on the dorsalis pedis artery was 0.46. the ankle-brachial index on the left based on the dorsalis pedis artery was 0.51. the patient is currently undergoing an magnetic resonance angiography of the lower extremities to further evaluate the arterial anatomy for possible bypass planning. the patient will require futher evaluation by the vascular surgery service for consideration of future lower extremity bypass. condition at time of this dictation: condition at the time of this discharge summary was stable and the patient remains on the inpatient medical service , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures insertion of endotracheal tube enteral infusion of concentrated nutritional substances arteriography of femoral and other lower extremity arteries diagnoses: coronary atherosclerosis of native coronary artery acute kidney failure, unspecified paroxysmal ventricular tachycardia ulcer of other part of foot pneumonitis due to inhalation of food or vomitus cardiogenic shock acute myocardial infarction of unspecified site, initial episode of care atherosclerosis of native arteries of the extremities with ulceration ulcer of heel and midfoot 

Answer: The patient is high likely exposed to